Lipoic acid choline ester compositions and methods to stabilize into pharmaceutically relevant drug products

ABSTRACT

The present invention describes ophthalmic lipoic acid choline ester compositions and specific processes to produce biocompatible formulations of said compositions suitable for the eye.

FIELD OF THE INVENTION

The present invention generally relates to pharmaceutically-compliant compositions comprising lipoic acid choline ester and specific compositions and methods to stabilize the compositions and minimize irritation to ocular tissue when applied as eye-drops. The compositions herein are contemplated as therapies for (but not limited to) ocular disorders such as presbyopia, dry eye, cataracts, and age-related macular degeneration.

BACKGROUND OF THE INVENTION

Lipoic acid choline ester (LACE) is a chemically synthesized derivative of R-α-Lipoic Acid.

Lipoic acid, also known as thioctic acid, is an eight carbon fatty acid with a disulfide linkage joining the carbons 6 and 8 to form an 1, 2-dithiolane ring. The acid forms optical isomers of which the isomer R-α-lipoic acid is the most biologically active.

Lipoic Acid Choline Ester (LACE, chemical structure, see FIG. 1 ) was designed to permeate biological membranes with the incorporation of the cationic choline head group. While lipoic acid does not permeate the cornea, the choline ester derivative of lipoic acid permeates the cornea, is hydrolyzed by corneal esterases and is transformed into the biologically active lipoic acid. LACE has been formulated into an ophthalmic solution to be applied twice daily as an eye-drop to treat presbyopia.

LACE, which is a prodrug consisting of lipoic acid and choline, is a unique molecule to treat presbyopia. Lipoic acid (LA) is the active ingredient and the choline head group serves to aid permeability into the eye. The bonds between LA and choline are hydrolyzed by esterases in the tear film and cornea after the eye drop is administered. The free lipoic acid enters the eye and ultimately reaches the lens. There it is reduced to dihydrolipoic acid by endogenous oxidoreductases which then cause hydrolysis of the cytosolic proteins within the superficial elongated lenticular cells. This protein cleavage allows a free flow of cytosol and reversal of the oxidative processes associated with the age-related stiffening of the lens. It is expected that ophthalmic solutions prepared from LACE will enable accommodation and improve near vision focus in persons with presbyopia, the age-related loss of accommodation.

Presbyopia is an age-related inability to focus on near objects; this condition is caused by physiological changes in the microstructure of the lens resulting in loss of flexibility in the auto-adjustment of focal length and curvature of the lens to bring the visual object under focus. This condition is corrected by corrective lenses. It has been reported that lipoic acid choline ester (“LACE”) (see e.g., U.S. Pat. No. 8,410,462) can restore near vision.

Supporting this claim are ex-vivo studies that demonstrated that lens softening can be induced pharmacologically in human donor lenses using the protein disulfide reducing agent dithiothreitol (DTT), and in mouse lenses with lipoic acid.

This mechanism of action allows the contemplation of treatment of multiple ocular diseases and disorders. These disorders are, but not limited to, presbyopia, age-related macular degeneration, cataract and dry eye.

An issue that has rendered formulation of LACE problematic has been the propensity to destabilize by ring-opening of the dithiolane linkage to form oxidized species that compromise the activity of the molecule. At room temperature, LACE rapidly degrades into oxidized species (See “HPLC Chromatogram of LACE Ophthalmic Solution with Degradation Products”, see FIG. 2 ). Even when stored at refrigerated temperatures, rapid oxidation occurs in storage as early as 1 week, comprising the utility of the molecule as a drug product. For LACE. Ophthalmic Solution (also referred to as EV06 Ophthalmic Solution) to be utilized in its fullest potential as a drug product, it was critical that the aqueous formulation be stabilized in storage and during use.

Another issue that confounded the pharmaceutical development of LACE ophthalmic solutions was incidences of ocular surface irritation observed in-vivo in a rabbit irritation model. The invention details unexpected parameters that contributed to, or caused ocular irritation and processes to eliminate or minimize these parameters. These parameters were not related to the formulation composition or properties of the drug substance, factors that normally correlated or attributed to ocular irritation.

The compositions and methods described within describe formulations and methods to stabilize ophthalmic LACE formulations long-term.

Also described arc unanticipated discoveries as to the cause of irritation of LACE formulations formulated under certain process conditions, The cause of irritation was correlated to aggregation of LACE salt molecules in water, as part of hydrophobic interactions with surrounding water molecules and ionic interactions with the counter- anion (chloride or iodide). Critical process parameters were identified as key factors in the generation of final, comfortable ophthalmic solutions of LACE Chloride (EV06 Ophthalmic Solution). For the chloride salt, the final process conditions minimized the formation of the degradation species and minimized the formation of species that were attributed to ocular irritation.

With LACE-Iodide, simple process optimization did not generate comfortable solutions. The aggregated species of LACE could not be dispersed when the salt form was iodide, due to the stabilization of the aggregated species by the larger iodide ion.

Once dissolved in an aqueous solution, For LACE-Iodide salt, the aggregation could not be dispersed once formed, settling upon a thermodynamically stable aggregated species that was approximately 39-41% of the LACE-Iodide peak. Correlations were made for associative species and ocular irritation. The second aspect of the invention is stabilization of a LACE Iodide drug product by generating inclusion complexes in cyclodextrins.

BRIEF SUMMARY OF THE INVENTION

The proposed invention achieves two primary objectives: (a) to generate ophthalmic solutions of LACE that are stable for at least a year at refrigerated storage temperatures of 2-5° C., and (h) to generate formulations (both LACE-Chloride and LACE-Iodide) that are non-irritating to the eye.

The chemical structure of LACE dictates two points of degradation. One is ring opening of the diothiolane ring and the other is oxidative and hydrolytic degradation, As mentioned earlier, LACE interacts with oxygen to rapidly generate oxidized species, in water, LACE is also susceptible to hydrolysis of the ester linkage to generate Lipoic Acid and Choline. The rate at which hydrolysis occurs is correlated to temperature; hydrolysis is less at lower temperatures and pH.

Studies were performed on LACE ophthalmic solution derivatives, also called EV06 Ophthalmic Solution, stored in permeable LOPE eye-dropper bottles, which are gas permeable. Described herein are methods that the inventors have developed to minimize oxidation of the compounded LACE solution during storage.

Additionally, extensive compatibility studies of excipient mixtures with LACE established the criticality of certain excipients as stabilizing factors, the role of pH in stabilization of the hydrolysis of LACE in water, as well as the effect of osmolality-adjusting agents such as sodium chloride and glycerol. Most importantly, the stabilizing effect of Alanine to LACE, as opposed to citrate, phosphate and borate has been described in the proposed invention.

While searching for causes for irritation, it was discovered that LACE, when dissolved in water, forms micelles and micellar aggregates, common to compounds that are amphiphilic in nature. As definition, examples of micelle-forming compounds are phosphatidyl choline, pegylated phosphatidyl choline, PEG-stearate, sorbitol, etc. While the micelle-formation phenomenon of LACE is not unexpected due to the amphiphilic nature of the molecule, the formation of these aggregates at lower temperatures were surprising. The presence of the aggregates was measured by a RP-HPLC method developed in-house. The measurement could be performed both with HPLC-UV and HPLC-ELSD. Both chloride and iodide salts of LACE form micellar aggregates in aqueous solutions, although the LACE iodide forms more stable aggregates in water, due to the stronger interaction of the iodide counter-ion and the cationic LACE molecule. The equilibrium concentration of LACE Iodide aggregates are 39-41% of the API peak. In comparison, the equilibrium concentration of LACE chloride is <1%, after dispersion with agitated stirring.

A. LACE CHLORIDE IN AQUEOUS SOLUTIONS

LACE chloride aqueous solutions formed gel-like structures at refrigerated temperatures (2-5° C.). It is also expected that the number and aggregation of these micellar assemblies increase with increase in concentration of the micelle-forming drug. The inventors have correlated the extent of micellar aggregation of LACE with ocular surface irritation, a result that was unanticipated and surprising, since micellar vehicles are often contemplated as drug delivery systems for insoluble compounds. Thus, this is the first reported account of irritation correlated to micellar aggregates. Once discovered, this phenomenon needed to be minimized through compounding methods to correlate with comfort.

The formation of micellar aggregates appeared to be correlated to the temperature of compounding (FIG. 4 ). The formation of self-assemblies is a thermodynamic phenomenon, correlated to efficient lowering of surface free energy to achieve a minimized energy state. When LACE was compounded in water at a lower temperature (5° C.), aggregates that had a gel-like consistency were formed. Compositions formulated at refrigerated temperatures were extremely irritating to the eye. The aggregated state could be quantitated by a RP-HPLC method (see chromatogram shown in FIGS. 12A-12B). A series of investigative experiments demonstrated no presence of polymers or oligomers, when measured by extensive Size Exclusion Chromatography (SEC). Other investigations tested ocular irritation as a function of processes conducted in the presence of ambient air or in the presence of nitrogen. There was no correlation of irritation to air or nitrogen. Both were equally comfortable when formulated at room temperature, although the degradation products were higher in the presence of air. When LACE was compounded at room temperature, the micellar aggregation was lower as quantitated by the HPLC method. LACE compounded at room temperature generated solutions that were comfortable and non-irritating.

Also unanticipated were the “disentangling” of the micellar aggregates. The aggregates formed in LACE aqueous compositions could he “disentangled” as the solutions were left to equilibrate on the benchtop at room temperature, as measured by HPLC. Additional experiments showed that the vigorous mixing achieved de-aggregation. Thus, it was proved that these species were not permanent species with covalent linkages, but rather a self-assembly of LACE aggregates that appeared to have a lower concentration at room temperature, compared to 5° C. LACE aqueous solutions when frozen, formed a stringy consistency. These solutions, when brought up to room temperature and stored at this temperature looked like homogeneous solutions again, lending further credence to concept of temperature dependence of self-assembly.

However, once compounded, aggregate-free solutions of LACE could he stored in refrigerated conditions to minimize oxidative and hydrolytic degradation. it was established through stability studies that the ideal storage temperature of LACE is 2--5° C., to minimize degradation events.

The ideal compounding conditions were determined to be at room temperature (22-25° C.) to yield the least irritating solution and the ideal storage condition was determined to be between 2-5° C., to achieve a stable, comfortable ophthalmic solution of LACE for presbyopia.

To further aid in the stabilization of ophthalmic solutions prepared from LACE, oxygen scavenger packets were placed in mylar, impermeable pouches with the LDPE ophthalmic bottles to prevent oxidation-induced degradation. Extensive stability studies demonstrated achievement of a year's stability of EV06 Ophthalmic Solutions.

Also described in this proposed invention are embodiments of various compositions that stabilize LACE, including other types of aqueous preparations including liposomes, emulsions compounded for the primary purpose of stabilization of the drug.

B. LACE IODIDE IN AQUEOUS SOLUTIONS

LACE Iodide in aqueous solutions form micellar aggregates (as do LACE Chloride) that cause irritation to ocular tissue. The experiments below describe some of the formulation methods to disrupt micellization.

Tn experiments where Sodium Chloride was either added to an existing LACE-Iodide formulation, or a solution containing Sodium Chloride was used to dissolve the LACE-Iodide API, the “associative species” peak was not significantly decreased.

In experiments where a co-solvent such as Ethanol or Propylene Glycol was used to suspend the API prior to addition of an aqueous vehicle, there was a very significant reduction in the percentage of the associative species. Addition of an organic solvent to an existing formulation also decreased the associative species peak, to a lesser extent.

These results point to formulation strategies that can interfere with the hydrophobic interaction between LACE molecules as a means of controlling the associative species.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates the chemical structure of lipoic acid choline ester (LACE).

FIG. 2 illustrates plots of LACE micellar species at 8.1 minutes at 1, 3 and 4 hours of mixing Formulation KW-LACE-01-86-2.

FIG. 3 illustrates plots of LACE micellar species at 8,1 minutes at 6, 8 and 24 hours of mixing Formulation KW-LACE-01-86-2,

FIG. 4 is a plot illustrating that micellar LACE species are highest when mixed at refrigerated temperatures.

FIG. 5 is a plot illustrating that high micellar LACE concentrations (denoted by large peak between 7,9 and 8.5 minutes on HPLC trace) is correlated to clumped LACE chloride.

FIG. 5B is a plot illustrating that lower micellar LACE concentration is correlated with non-clumped LACE chloride.

FIG. 6 is a plot illustrating the effect of alanine as a function of pH.

FIG. 7 is a plot illustrating the stability of BAC-Tree and glycerol-Tree formulations.

FIG. 8 is a plot illustrating the stability of sulfite-containing formulations.

FIG. 9 is a plot illustrating the stability of BAC-free LACE compositions.

FIG. 110 is a plot illustrating the stability of glycerin-free LACE compositions.

FIG. 11 is a plot illustrating the effect of buffered compositions on LACE stability.

FIG. 12A is a plot illustrating the correlation of irritation score (in a rabbit irritation model) with % LACE micellar species measure by HPLC-UV.

FIG. 12B is a plot illustrating the correlation of irritation score (in a rabbit irritation model) with % LACE miceliar species measure by HPLC-ELSD.

FIG. 12C is a glycerol standard curve.

FIG. 13A is an HPLC plot of FK-LACE-02-15. 1.92% LACE-Iodide (Lot 092309), with 1.8% NaCl added (T=0 hours).

FIG. 13B is an HPLC plot of FK-LACE-02-15, 1.92% LACE-Iodide (Lot 092309), with 1.8% NaCl added (T=4 hours).

FIG. 13C is an HPLC plot of LACE-Iodide (lot 011510), dissolved in pH 4.5 buffer with 1,8% NaCl.

FIG. 14 is an HPLC plot of LACE-Iodide (Lot 011510), dissolved in 78% ethanol.

FIG. 15 is an HPLC plot of LACE-Iodide (Lot 011510), dissolved in 10% propylene glycol.

FIG. 16 is an HPLC plot of LACE Iodide formulated in sulfobutyl ether cyclodextrin.

FIG. 17 is an HPLC plot of LACE iodide formulated with polypropylene glycol to disrupt micellization.

FIG. 18 is a plot illustrating the effect of HP-B-CD on LACE Iodide oxidation,

FIG. 19 is a plot illustrating the effect of FTP-B-CLQ on total impurities of LACE Iodide.

FIG. 20 is a plot comparing LACE-Chloride original formulation and LACE-Iodide HP-B-CD.

FIG. 21 is a calculation of activation energy of oxidized species formation (LACE-Iodide/HP-B-CD versus LACE-Chloride non-HP-B-CD formulation).

FIG. 22 is a Calculation of activation energy of lipoic acid formation (LACE-Iodide/HP-B-CD versus LACE-Chloride non-HP-B-CD formulation).

FIG. 23 is a Franz cell for corneal permeability studies.

FIG. 24 is a permeation of lipoic acid in Study 1 (Corneas 1-3: 1.92% LACE-I with 7.4% FTP-B-CD; Corneas 4-6: 1.5% LACE-Cl, no HP-B-CD).

FIG. 25 is a graph showing the permeation of LACE in Study 1.

FIG. 26 is a graph showing the permeation of LACE in Study 2.

FIG. 27 is a graph illustrating lipoic acid extracted from corneas in Study 2 (Corneas 1-3: 3.0% LACE-iodide formulation; corneas 4-6: 4.5% LACE-iodide formulation).

FIG. 28 is a graph showing the permeation of LACE in Study 3.

FIG. 29 is a graph illustrating lipoic acid extracted from corneas in Study 3 (Corneas 1-3: 3.0% LACE-iodide/HP-B-CD formulation; corneas 4-6: 4.5% LACE-iodide/no HP-B-CD formulation).

FIG. 30 is a graph showing the permeation of LACE in Study 4.

FIG. 31 is a graph illustrating lipoic acid extracted from corneas in Study 4 (Corneas 1-3: 1.92% LACE-iodide/HP-B-CD formulation; corneas 4-6: 1.92% LACE-odide/no HP-B-CD formulation).

FIG. 32 is a plot illustrating change over time in the area percent of associative species as a function of the amount of HP-B-CD in formulation [expressed as mole equivalence (M.E) relative to one mole of LACE].

DETAILED DESCRIPTION OF THE INVENTION A. DEFINITIONS OF TERMS

The term “EV06,” “LACE” or “lipoic acid choline ester” is understood to have the following chemical structure as shown in FIG. 1 .

As used herein, LACE formulations refer to lipoic acid choline ester formulations. For example, LACE-Chloride 1.5% formulation refers to a formulation having 1.5% lipoic acid choline ester chloride by weight of the formulation. Alternatively, EV06 Ophthalmic Solution, 1.5% refers to a formulation that is comprised of 1.5% lipoic acid choline ester chloride salt. LACE-Iodide 3% refers to a solution that is comprised of 3% LACE-Iodide by weight of the formulation.

As used herein, a “derivative” of lipoic acid choline ester is understood as any compound or a mixture of compounds, excluding lipoic acid and choline, formed from reacting lipoic acid choline ester with a non-aqueous pharmaceutical excipient.

As used herein, the term “self-assembly” denotes a thermodynamic assembling of molecules to achieve the most stable energy state. An example of self-assembly are micelles formed in water, typically formed by molecules with a hydrophobic component and a hydrophilic component. The hydrophilic component of the molecule is on the surface of micelles, while the interior contains the hydrophobic parts; for LACE, the choline head group is on the surface of the micelle.

Unless specifically stated or obvious from context, as used herein, the term “excipient” refers to pharmaceutically acceptable excipient.

The term “treating” refers to administering a therapy in an amount, manner, or mode effective to improve a condition, symptom, or parameter associated with a disease or disorder.

The term “preventing” refers to precluding a patient from getting a disorder, causing a patient to remain free of a disorder for a longer period of time, or halting the progression of a disorder, to either a statistically significant degree or to a degree detectable to one skilled in the art.

The term “therapeutically effective amount” refers to that amount of an active ingredient (e.g., LACE or derivatives thereof), which results in prevention or delay of onset or amelioration of symptoms of an ocular disease or disorder (e.g., presbyopia) in a subject or an attainment of a desired biological outcome, such as improved. accommodative amplitude or another suitable parameter indicating disease state.

As used herein, the term “shelf-stability” or “shelf stable” is understood as a character of or to characterize a composition or an active ingredient (e.g., LACE or derivatives thereof) that is substantially unchanged upon storage. Methods for determining such shelf stability are known, for example, shelf-stability can be measured by HPLC to determine the percentage of the composition or active ingredient (e.g., lipoic acid choline ester) that remains or has been degraded in a formulation following storing the formulation for a certain period of time. For example, shelf stable pharmaceutical composition can refer to a composition, which after being stored as per pharmaceutical standard (ICH) has at least 90% (e.g., 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or greater than 99%) of the active ingredient lipoic acid choline ester) present in the composition as measured by HPLC.

As used herein, the term “relative retention lime” or “RRT” of a compound can be calculated using the equation “RRT=(t₂−t₀)/(t₁−t₀),” wherein t₀=void time, t₁=retention time of lipoic acid choline ester, and t₂=retention time of the compound, as measured by HPLC.

The term “subject” as used herein generally refers to an animal (e.g., a pet) or human, including healthy human or a patient with certain diseases or disorders (e.g., presbyopia).

Lace Compositions and Embodiments

As described herein, the proposed invention provides embodiments of pharmaceutical compositions comprising therapeutically effective amounts of lipoic acid choline ester, excipients, buffers and conditions that are compatible and methods and processes that result in biocompatible (non-irritating) and stable solutions suitable as ophthalmic eye-drops.

Concentration of lipoic acid choline ester or derivatives thereof in the pharmaceutical composition can be any concentration from 0.01-0.1%. 0.1% to 10% (e.g., 0.1%, 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, or any ranges based on these specified numeric values) by weight of the composition, in some embodiments, the concentration of the lipoic acid choline ester in the pharmaceutical composition is 1%. In some embodiments, the concentration of the lipoic acid choline ester in the pharmaceutical composition is 3%. In some embodiments, the concentration of the lipoic acid choline ester in the pharmaceutical composition is 4%. The preferred range of LACE in the composition is 1-3%. Within this range, the preferred composition range is 1,5-5%, The salt form of LACE can be either Iodide or Chloride.

In another embodiment, the effective compositions in the proposed invention are aqueous formulations contain LACE (chloride or iodide) and Alanine, with Alanine at concentrations between 0.1-0.5% , 0.5%-1%, 1%-1.5%, 1.5%-3%, 1.5-5%. Within this range, the preferred composition is 0.5% Alanine and L1.5% LACE. Another preferred embodiment is 0.5% Alanine and 1.5-4% LACE-Iodide or LACE Chloride,

In a preferred embodiment, the effective LACE salt form and Alanine-containing composition contains benzalkonium chloride as a preservative at concentrations between 30-150 ppm.

In another embodiment, the effective LACE. salt form and Alanine-containing drug product composition contains no preservative.

In another embodiment, other preservatives such as polyquartenium, polyhexamethylene Biguanide (PHMB), sofZia is included in the LACE aqueous formulation as preservatives at concentrations approved for human use by the FDA. Other preservatives can be 2-phenyl ethanol, boric acid, disodium edetate,

Since self-assembled micellar solutions of LACE. salt dissolved in water at high concentrations may demonstrate some irritation, a method to render biocompatible solutions may be encapsulation in liposomes. In this case, LACE will be contained in the interior of the liposomes. Liposomes are generally biocompatible with the ocular surface, In another example, LACE salt is encapsulated by complexomg with a cyclodextrin, such as sulfobutylether cyclodextrin or hydroxypropyl beta cyclodextrin.

In another embodiment, the pharmaceutical composition has glycerol in concentrations of 0.1%40%. In a preferred embodiment, the composition has a glycerol concentration of 0.1-5%.

In some embodiments, the preservative is benzalkonium chloride and the biochemical energy source is alanine. In some embodiments, the lipoic acid choline ester has a counter ion selected from the group consisting of chloride, bromide, iodide, sulfate, methanesulfonate, nitrate, maleate, acetate, citrate, fumarate, hydrogen fumarate, tartrate (e.g., (+)-tartrate, (−)-tartrate, or a mixture thereof), bitartrate_(;) succinate, benzoate, and anions of an amino acid such as glutamic acid.

Suitable buffer agent can be any of those known in the art that can achieve a desired pH (e.g., described herein) for the pharmaceutical composition. Non-limiting examples include phosphate buffers (e.g., sodium phosphate monobasic monohydrate, sodium phosphate dibasic anhydrous), acetate buffer, citrate buffer, borate buffers, and HBSS (Hank's Balanced Salt Solution). Suitable amounts of a buffer agent can be readily calculated based on a desired pH. In any of the embodiments described herein, the buffer agent is in an amount that is acceptable as an ophthalmic product. However, in some embodiments, the pharmaceutical composition does not include a buffer agent. In some embodiments, the pH of the aqueous solution or the final pharmaceutical composition is adjusted with an acid (e.g., hydrochloride acid) or a base (e.g., sodium hydroxide) to the desired pH range (e.g., as described herein).

In other embodiments, the buffer system could he selected from borate buffers, phosphate buffers, calcium buffers and combinations and mixtures thereof. In the preferred embodiment, the buffer is an amino acid buffer. In another preferred embodiment, the amino acid buffer is comprised of Alanine.

In some embodiments, the lipoic acid choline ester has a counter ion selected from the group consisting of chloride, bromide, iodide, sulfate, methanesulfonate_(;) nitrate, maleate, acetate, citrate, fumarate, hydrogen fumarate, tartrate, (e.g., (+)-tartrate, (−)-tartrate, or a mixture thereof), succinate, benzoate, and anions of an amino acid such as glutamic acid. Other counter ions are stearate, propionate and furoate.

In some embodiments, the ophthalmic formulation has a pH of 4 to 8, In some embodiments, the ophthalmic formulation has a pH of 4.5. In some embodiments, the ophthalmic formulation comprises at least one ingredient selected from the group consisting of a biochemically acceptable energy source, a preservative, a buffer agent, a tonicity agent, a surfactant, a viscosity modifying agent, and an antioxidant.

In some embodiments, the pharmaceutical composition contains an anti-oxidant. In some preferred embodiments, the anti-oxidant is comprised of ascorbate. In another preferred embodiment, the anti-oxidant contains glutathione. Suitable antioxidant can be any of those known in the art. Non-limiting examples include ascorbic acid, L-ascorbic acid stearate, alphathioglycerin ethylenediaminetetraacetic acid, erythorbic acid, cysteine hydrochloride, N-acetylcystgeine, L-carnitine, citric acid, tocopherol acetate, potassium dichloroisocyanurate, dibutylhydroxytoluene, 2,6-di-t-butyl-4-methylphenol, soybean lecithin, sodium thioglycollate, sodium thiamalate, natural vitamin E, tocopherol, ascorbyl pasthyminate, sodium pyrosulfite, butylhydroxyanisole, 1,3-butylene glycol, pentaerythtyl tetrakis[3-(3,5-di-t-butyl-4-hydroxyphenyl)]propionate, propyl gallate, 2-mercaptobenzimidazole and oxyquinoline sulfate. Suitable amount of antioxidant can be in the range of 0.1% to 5% 0.1%, 0.5%, 1%, 2%, 3%, 4%, 5%, or any ranges based on these specified numeric values) by weight of the composition. In any of the embodiments described herein, the antioxidant is in an amount that is ophthalmically acceptable.

In some embodiments, the pharmaceutical composition is prepared by compounding under an inert environment such as high purity nitrogen or argon. In a preferred embodiment, the pharmaceutical composition is compounded under a nitrogen environment with less than 2 ppm of oxygen.

In some embodiments, the pharmaceutical composition is prepared by compounding at temperatures between 20-25° C.

In a preferred embodiment, the solid LACE molecule is ground up into a fine powder. Preferably, the solid LACE molecule is ground up into a powder with no clumps. In an embodiment, the particle size will be less than 500 microns, in another preferred embodiment, the particle size will be less than 100 microns.

In a preferred embodiment, the pharmaceutical composition is prepared by initial de-aeration of the aqueous solution maintained at room temperature (20-25° C.), then dissolution of the excipients in the solution, followed by adding the solid LACE slowly in parts under vigorous dissolution under nitrogen slow sparging.

in one embodiment, the pharmaceutical composition is stirred vigorously for 4 hours to 24 hours. In a preferred embodiment, the pharmaceutical composition is stirred vigorously from 4 to 8 hours. In another preferred embodiment, the pharmaceutical composition is stirred vigorously for 8 hours.

The pharmaceutical composition prepared by either method can have a shelf-stability of at least 3 months (e.g., 3 months, 6 months, 9 months, 1 year, or more than 1 year),

The pharmaceutical composition can also have favorable profiles of drug related degradant (e.g., total drug related impurities, or amount of a specific drug related impurity) following storage at 5 ° C. for a certain period of time. Analytical tools (e.g., HPLC) for measuring the amount of drug related degradant in a formulation are known.

Suitable biochemically acceptable energy source can be any of those known in the art. For example, the biochemical acceptable energy source can be any of those that can facilitate reduction by participating as an intermediate of energy metabolic pathways, particularly the glucose metabolic pathway. Non-limiting examples of suitable biochemically acceptable energy source include amino acids or derivative thereof (e.g., alanine, glycine, leucine. isoleucine, 2-oxoglutarate, glutamate, and glutamine, etc.), a sugar or metabolites thereof (e,g., glucose, glucose-6-phosphate (G6P)), pyruvate (e.g., ethyl pyruvate), lactose, lactate, or derivatives thereof), a lipid (e.g., a fatty acid or derivatives thereof such as mono-, di-, and tri-glycerides and phospholipids), and others (e.g., NADH). Suitable amount of a biochemically acceptable energy source can be in the range of 0.01% to 5% (e g 0.05%, 0.1%, 0.2%, 0.5%, 1%, 2%, 3%, 4%, 5%, or any ranges based on these specified numeric values) by weight of the composition. In some embodiments, the biochemical energy source is ethyl pyruvate. In some embodiments, the biochemical energy source is alanine. In some embodiments, the amount of ethyl pyruvate or alanine is in the range of 0.05% to 5% (e.g., 0.05%, 0.1%, 0.2%, 0.5%, 1%, 2%, 3%, 4%, 5%, or any ranges based on these specified numeric values) by weight of the composition. In some embodiments, the amount of alanine is 0.5% by weight of the composition. In any of the embodiments described herein, the biochemically acceptable energy source is in an amount that is ophthalmically acceptable.

Suitable preservatives can be any of those known in the art. Non-limiting examples include benzalkonium chloride (BAC), cetrimonium, chlorobutanol, edetate disodium (EDTA), polyquatemium-1 (Polyquad®), polyhexamethylene biguanide (PHMB), stabilized oxychloro complex (PURITE®) sodium perborate, and SofZia®. Suitable amount of a preservative in the pharmaceutical composition can be in the range of 0.005% to 0.1% (e.g,, 0.005, 0.01, 0.02%, 0.05%, 0.1%, or any ranges based on these specified numeric values) by weight of the composition. In some embodiments, the preservative is benzalkonium chloride. In some embodiments, the benzalkoniuin chloride is in the amount of 0.003% to 0.1% (e.g., 0.003, 0.01, 0.02%, 0.05%, 0.1%, or any ranges based on these specified numeric values) by weight of the composition. In some embodiments, the benzalkonium chloride is in the amount of 0.01% by weight of the composition. In any of the embodiments described herein, the preservative is in an amount that is ophthalmically. acceptable. In some embodiments, the pharmaceutical composition is free of a preservative.

Suitable tonicity agents can be any of those known in the art. Non-limiting examples include sodium chloride, potassium chloride, mannitol, dextrose, glycerin, propylene glycol and mixtures thereof. Suitable amount of tonicity agent in the pharmaceutical composition is any amount that can achieve an osmolality of 200-460 mOsni (e.g., 260-360 mOsm, 260-320 mOsm). in some embodiments, the pharmaceutical composition is an isotonic composition. In some embodiments, the amount of a tonicity agent (e.g., sodium chloride) is 0.1% to 5% (e.g., 0.1%, 0.5%, 1%, 2%, 3%, 4%, 5%, or any ranges based on these specified numeric values) by weight of the composition. In any of the embodiments described herein, the tonicity agent is in an amount that is ophthalmically acceptable.

Suitable surfactant can be any of those known in the art, including ionic surfactants and nonionic surfactants. Non-limiting examples of useful nonionic surfactants include polyoxyethylene fatty esters (e.g., polysorbate 80 [poly(oxyethylene)sorbitan monooleate], polysorbate 60 [poly(oxyethylene)sorbitan monostearate], polysorbate 40 [poly(oxyethylene)sorbitan monopalmitate], poly(oxyethylene)sorbitan monolaurate, poly(oxyethylene)sorbitan trioleate, or polysorhate 65 [poly(oxyethylene)sorbitan tristearate]), polyoxyethylene hydrogenated castor oils (e.g., polyoxyethylene hydrogenated castor oil 10, polyoxyethylene hydrogenated castor oil 40, polyoxyethylene hydrogenated castor oil 50, or polyoxyethylene hydrogenated castor oil 60), polyoxyethylene polyoxypropylene glycols (e.g., polyoxyethylene (160) polyoxypropylene (30) glycol [Pluronic F681], polyoxyethylene (42) polyoxypropylene (67) glycol [Pluronic P123], polyoxyethylene (54) polyoxypropylene (39) glycol [Pluronic P85], polyoxyethylene (196) polyoxypropylene (67) glycol [Pluronic F1271], or polyoxyethylene (20) polyoxypropylene (20) glycol [Pluronic L-441]), polyoxyl 40 stearate, sucrose fatty esters, and a combination thereof. In some embodiments, the surfactant is polysorhate 80, Suitable amount of surfactant in the pharmaceutical composition can be in the range of 0.01% to 5% (e.g., 0.05, 0.1, 0.2%, 0.5%, 1%, 2%, 3%, 4%, 5%, or any ranges based on these specified numeric values) by weight of the composition. In some embodiments, the surfactant is polysorbate 80, and the amount of polysorbate 80 is in the range of 0.05% to 5% (e.g., 0.05, 0.1, 0.2%, 0.5%, 1%, 2%, 3%, 4%, 5%, or any ranges based on these specified numeric values) by weight of the composition. In some embodiments, the amount of polysorbate 80 is 0.5% by weight of the composition. In any of the embodiments described herein, the surfactant is in an amount that is ophthalmically. acceptable. :However, in sonic embodiments, the pharmaceutical composition is free of a surfactant.

Suitable viscosity modifying agent can be any of those known in the alt. Non-limiting examples include carbopol gels, cellulosic agents (e.g., hydroxypropyl methylcellulose), polycarbophil, polyvinyl alcohol, dextran, gelatin glycerin, polyethylene glycol, poloxamer 407, polyvinyl alcohol and polyvinyl pyrrolidone and mixtures thereof. Suitable amount of viscosity modifying agent can be in the range of 0.1% to 5% (e.g., 0.1%, 0.5%, 1%, 2%, 3%, 4%, 5%, or any ranges based on these specified numeric values) by weight of the composition. In any of the embodiments described herein, the viscosity modifying agent is in an amount that is ophthalmically acceptable. In some embodiments, the pharmaceutical composition is free of a viscosity modifying agent (e.g., a polymeric viscosity modifying agent such as hydroxypropyl methylcellulose).

In some embodiments, the pharmaceutical composition is characterized by one or more of the following:

-   (a) having a concentration of the lipoic acid choline ester salt     from 0.1% to 10% (e.g., 0.1%, 1.0%, 1.5%, 3%, 4%, 5%, or any ranges     between the specified numeric values) by weight of the composition; -   (b) having a concentration of a preservative (e.g., benzalkonium     chloride) of 0.003% to 0,1% (e.g., 0.01%) by weight of the     composition; -   (c) having a biochemical energy source (e.g., alanine) of 0.1% to 5%     (e.g., 0.5%) by weight of the composition; and -   (d) having a concentration of glycerol of 0.5% to 5% (e.g., 2.7%) by     weight of the composition. -   e) having a concentration of hydroxypropyl beta cyclodextrin of 1%     to 20% by^(,) weight of the composition. -   f) having a concentration of hydroxypropyl methyl cellulose (UPMC)     of 0.1-0.5% by weight of the composition.

In some embodiments, the pharmaceutical composition consists essentially of 1-3% by weight of glycerin, 0.5% by weight of alanine, 0.005-0.01% by weight of benzalkonium chloride, 1-3% by weight of lipoic acid choline ester, and water, wherein the pH of the pharmaceutical composition is 4.3 to 4.7.

In some embodiments, the pharmaceutical composition consists essentially of 1-3% by weight of glycerin, 0.5% by weight of alanine, 1-30% hydroxypropyl beta cyclodextrin, 0.005-0.01% by weight of benzalkonium chloride, 1-3% by weight of a pharmaceutical salt of lipoic acid choline ester, and water, wherein the pH of the pharmaceutical composition is 4.3 to 4.7.

In another embodiment, the pharmaceutical salt form of lipoic acid choline ester is a chloride.

In another embodiment, the pharmaceutical salt form of lipoic acid choline ester is an iodide.

In another embodiment, the pharmaceutical salt form of lipoic acid choline ester is among the group, but not limited to chloride, bromide, iodide, mesylate, phosphate, tosylate, stearate. methanesulfonate.

In another embodiment, the viscosity enhancing agent is methyl cellulose, hydroxypropyl methyl cellulose, polyvinyl alcohol, polyvinyl pyrrolidone.

In a preferred embodiment, the preferred viscosity enhancing agent is hydroxypropyl methyl cellulose in concentrations 0.1-0.5%.

In another embodiment, an antioxidant is added to stabilize LACE.

Suitable anti-oxidants can be ascorbates, glutathione, histidine, methionine, cysteine.

In another embodiment, the pIl of the composition is between 4 and 5.

In one embodiment, the ophthalmic composition is dosed to each eye of the subject once daily, twice daily, thrice daily and four times daily.

In some embodiments, the invention also provides a system for storing a pharmaceutical composition comprising an active ingredient in an aqueous solution, wherein the active ingredient (e.g., lipoic acid choline ester or derivatives thereof) is susceptible to hydrolysis in the aqueous solution. In a preferred embodiment, the pharmaceutical composition is stored in a LDPE ophthalmic eye-dropper bottle, overlaid with nitrogen during the filling process, capped, then packed in a secondary mylar, gas-impermeable pouch containing an oxygen absorbent.

In another embodiment, the eye-dropper bottle or unit is polyethylene terephthalate (PET). In another embodiment, the eye-dropper bottle is constructed of a material that has low gas permeability.

In another embodiment, the eye-dropper bottle or unit is a glass ophthalmic bottle with a polypropylene dropper tip for dispensation into the eye.

In other embodiment, eyedropper bottle can be constructed of any material that has a low gas permeability. In another embodiment, the eye-dropper bottle can he unit dose, filled by blow fill seal techniques.

In one embodiment, the pharmaceutical composition is stored at 2-5° C. for a period of 3 months to 2 years.

Methods of Treatment

The pharmaceutical compositions comprising lipoic acid choline ester or derivatives thereof (e.g., as described herein) can be employed in a method for treating or preventing a disease or disorder associated with oxidative damage. Diseases or disorders associated with oxidative damage are known.

In some embodiments, the invention provides a method of treating an ocular disease in a subject in need thereof, comprising administering to an eye of the subject a therapeutically effective amount of any of the pharmaceutical compositions described herein.

In some embodiments, the ocular diseases are presbyopia, dry eye, cataract, macular degeneration (including age-related macular degeneration), retinopathies (including diabetic retinopathy), glaucoma, or ocular inflammations. In some embodiments, the ocular disease is presbyopia.

Suitable amount of pharmaceutical compositions for the methods of treating or preventing an ocular disease herein can he any therapeutically effective amount. In some embodiments, the method comprises administering to the eye of the subject an amount of the phannaceutical composition effective to increase the accommodative amplitude of ⁻the lens by at least 0,1 diopters (D) (e.g., 0.1, 0.2, 0.5, 1, 1.2, 1.5, 1.8, 2, 2.5, 3, or 5 diopters). In some embodiments, the method comprises administering to the eye of the subject 1-5 drops (about 40 uL per drop) of the pharmaceutical composition. In some embodiments, the eye of the subject is treated with the pharmaceutical composition 1, 2, 3, 4, 5, or more than 5 times a day, each time with 1-5 drops (about 40 μL per drop). In some embodiments, the lens or eye of the subject is treated with the pharmaceutical composition 1, 2, 3, 4, 5, or more than 5 drops each time. In some embodiments, the eye of the subject is treated with the pharmaceutical composition herein twice or three times per day, each time with 1 or 2 drops (about 40 uL per drop).

The methods include preventative methods that can be performed on patients of any age. The methods also include therapeutic methods that can be performed on patients of any age, particularly patients that are between 20-75 years of age.

The following examples are illustrative and do not limit the scope of the claimed embodiments.

EXAMPLES Example 1 Chemical Structure and General Properties of Lipoic Acid Choline Ester Chloride (LACE)

TABLE 1 General Properties of Lipoic Acid Choline Ester (LACE) Appearance: Solubility Profile: >50 mg/mL in water >4 mg/mL in acetonitrile Solution pH 7-7.5 Log P <2 Specific rotation: 70.3° Optical rotation: 0.338 at 25° C. at 0.005 g/mL in acetonitrile Spectral properties: UV A_(max) 333 nm Hygroscopicity: Highly hygroscopic Crystallinity: Sharp crystalline melt transition not observed, mostly amorphous Polymorphs: Not known at this time Particle size: D₅₀: 100-200 mm Melting/boiling range: Thermal transition observed at 230-235° C.

Example 2 Kinetics of Micellar Species Correlated to the Duration of Mixing of LACE Chloride Process Solutions

The experiments described in this section demonstrate that the LACE Chloride micellar species stabilize and diminish over extended mixing times at 25° C. The results demonstrated that the reversible nature of these species characteristic of self-assembled systems such as micelles and micellar aggregates.

Micellar species formed by spontaneous self-assembly of molecules are driven by the total free energy of the equilibrated system. The experiment demonstrated the kinetics of achievement of that equilibrated state with longer durations of mixing.

Objectives:

-   -   Establish process-time bracket by establishing if growing         micellar species has stabilized.     -   Establish “holding time”

Procedure:

-   -   Two 200-g batches of 1.5% LACE Chloride were prepared at 25° C.         after vehicle was deoxygenated with bubbled nitrogen. Nitrogen         was continually bubbled during dissolution of LACE.

-   One batch was prepared using GMP Batch #2 (G2-14LAC) as is, with     significant clumps, the other was prepared using a sample of     G2-14LAC that had been ground into a fine powder using a mortar and     pestle.

-   After dissolution of the LACE and pH adjustment, the batches were     stirred. for 24 hours with a constant nitrogen overlay, maintaining     dissolved oxygen at ˜1.6 ppm (vs. 8.2 ppm saturated solubility). At     time-points of 1 h, 3 h, 4 h, 6 h, 8 h, 9 h, and 24 h, about 5-15 mL     was removed by syringe and sterile-filtered into eye-dropper bottles     (5 mL/bottle), without nitrogen overlay in the bottle (apparatus was     in use for the bulk batches).

-   Samples of all time-points were diluted to 10 mg/g, and then     injected for RP-HPLC analysis with ELK.) detection within 30 minutes     of removal from the bulk solution.

-   After the 24-hour time-point, bulk solutions were sterile-filtered,     and each divided into two ˜50 mL portions—one held at 5° C., the     other 50-mL portion held at 25° C. All portions were overlaid with     nitrogen blown into the vessel.

-   At the end of the additional 24-hour hold time, each portion was     filled into eye-dropper bottles with a nitrogen overlay in the     bottle.

Observations on Dissolution

-   The clumped portion of G2-14LAC was added to formulation     KW-LACE-01-86-1 over about 5 minutes, and some of the clumps     required another 20 minutes to dissolve. -   The powdered G2-14LAC was added to formulation KW-LACE-01-86-2 over     about 15 minutes, because each spatula-full aggregated into a thin     raft of material floating on the surface, which did not disperse     immediately. Therefore another portion was not added until previous     portions were drawn into the vortex. Estimated time for any one     portion to dissolve was about 10 minutes, and the whole process took     approximately 25 minutes.

Results

-   A peak at RI=8 minutes (correlated with the micellar species) was     evident in both formulations from the first time-point taken. -   There were no consistent differences between the two batches in the     % Area of the 8 min. peak (micellar species), though the 2^(nd)     batch, made with powdered LACE chloride, had higher levels of the     micellar species at some time-points. -   The %Area of the 8 min. peak was significantly reduced at 24 hours,     as shown in the table below. -   Final pH was 4.54, for both batches.

TABLE 2 Kinetics of the Formation and De-Agglomeration of LACE Micellar Species with Extensive Mixing of LACE Chloride Percent Area of RT = 8 min. broad peak (LACE Micellar Species) Total area of LACE and related peaks (Results are for 1^(st) injection from HPLC vial, unless noted) KW-LACE-01-86-1 KW-LACE-01-86-2 1.5% LACE, made from 1.5% LACE, made from G2-14LAC with clump G2-14LAC ground up Mixing Time % micellar species % micellar species (Hours) at 8 minutes at 8 minutes 1 hour  0.30% 0.63% 2 hours 0.51% 0.56% 3 hours 0.56% 0.67% 4 hours 0.50% 0.44% 6 hours 0.64% 0.70% 8 hours 0.47% 0.44% 9 hours 0.42% 0.44% 24 hours  0.07% 0.17% 48 h (5° Not detected 0.09% C. hold) 48 h (25° Not detected Not detected C. hold)

The results demonstrate that LACE Chloride micellar species at 8.1 minute are minimized with extended mixing times. The peak at 8.1 minutes is diminished dramatically with longer mixing times.

Each of the solutions was also measured for degradants of lipoic acid choline ester. As mentioned earlier, the degradation mechanism of LACE is oxidative and hydrolytic, resulting in oxidized and hydrolyzed species.

TABLE 3 Impurity (Related Substances) Analysis of EV06 Ophthalmic Solution as a Function of Mixing KW-LACE-01-86-1:G2-14LAC with clumps TimePoint 

1 hour 3 hours 4 hours Related Specification RRT 0.50 0.28% RRT 0.50 0.37% RRT 0.50 0.38% RRT 0.54 0.14% RRT 0.54 0.16% RRT 0.54 0.16% Individual RRT 0.57 0.16% RRT 0.57 0.18% RRT 0.57 0 18% Compounds Report 2: 0.1% Lipoic Acid 0.02% Lipoic Acid 0.03% Lipoic Acid 0.03% (% Area) RRT 1.61 0.17% RRT 1.61 0.17% RRT 1.61 0.16% Total: Report Total 0.77% Total 0.91% Total 0.91% KW-LACE-01-86-1:G2-14LAC with clumps TimePoint 

6 hours 8 hours 9 hours Related Specification RRT 0.50 0.43% RRT 0.50 0.47% RRT 0.50 0.49% RRT 0.54 0.17% RRT 0.54 0.17% RRT 0.54 0.18% Individual RRT 0.57 0.19% RRT 0.57 0.20% RRT 0.57 0.20% Compounds Report 2: 0.1% Lipoic Acid 0.03% Lipoic Acid 0.03% Lipoic Acid 0.03% (% Area) RRT 1.61 0.16% RRT 1.61 0.16% RRT 1.61 0.16% Total: Report Total 0.98% Total 1.02% Total 1.05% KW-LACE-01-86-1:G2-14LAC with clumps TimePoint 

48 hours 48 hours 5° C. hold 25° C. hold 24 hours after first 24 h after first 24 h Related Specification RRT 0.50 0.65% RRT 0.50 0.68% RRT 0.50 0.89% RRT 0.54 0.20% RRT 0.54 0.17% RRT 0.54 0.21% Individual: RRT 0.57 0.25% RRT 0.57 0.20% RRT 0.57 0.27% Compounds Report 2: 0.1% Lipoic Acid 0.04% Lipoic Acid 0.05% Lipoic Acid 0.06% (% Area) RRT 1.61 0.16% RRT 1.61 0.17% RRT 1.61 0.20% Total: Report Total 1.31% Total 1.27% Total 1.61%

The data shows that the degradation products of LACE rise with extended mixing time. Thus, final process conditions for the compounding of EV06 Ophthalmic Solution involved a maximum of 8 hours to achieve a non-irritating solution with minimized degradants.

A similar mixing experiment performed with LACE Iodide did not result in a solution that had minimal aggregation. In fact, in the case of LACE iodide, the aggregated species were as high as 39% of the API at the end of 8 hours of mixing.

Example 3 Correlation of Mixing Temperature with Presence of Micellar LACE Chloride Species

The data shown in FIG. 4 is of a solution of LACE Chloride formulated under argon and refrigerated conditions. The solution was extremely irritating to the ocular surface. The percent micellar species was 8-10% of the main LACE API Peak (micellar species denoted by arrow, at retention time 7.9-8.1 minutes), a concentration that is normally not observed in solutions mixed at room temperature.

Example 4 Correlation of the Clumps to the Formation of Micellar LACE Species

FIG. 5A is a RP-HPLC chromatogram of EV06 Ophthalmic Solution prepared from a LACE Chloride hatch that had solid “clumps”. The solution prepared from this lot of API (active pharmaceutical ingredient, solid LACE drug substance) showed a higher percentage (10-15%) of the micellar LACE species (shown with an arrow) than solutions prepared from a lot of API that was powdery (FIG. 5B).

Thus, while both solutions looked completely dissolved, the solution formulated from non-clumped API had a lower concentration of micellar LACE species (see FIG. 5B). When correlated to ocular irritation, the solution shown in FIG. 5A had higher scores for irritation in a rabbit model. This led to incorporation of de-clumping procedures to render powdered material, prior to compounding.

Example 5 Compatibility Studies of Excipients with LACE Summary

The purpose of these experiments was to tease out possible destabilizing variables in the formulation, through systematic variations in formulation composition and micro-environment (such as pH). Lipoic acid, and any derivatives of lipoic acid would be subject to degradation and polymerization in heat, light and oxygen, leading to opening of the dithiolane ring. Thus, presence of excipients that can induce oxidative free radical scission could be destabilizing factors. The formulation grids 1 and 2, systematically investigated the effect of excipients already present in the formulation as possible destabilizing factors.

The formulation composition for LACE in these experiments contains the drug substance, alanine, glycerin, benzalkonium chloride in purified water, in 1N sodium hydroxide, or 1N hydrochloric acid added to achieve a pH between 4.4-4.6 and an osmolality of 290-300 mOsm/kg. The experiments described in this document were compatibility studies to identify excipients that could stabilize LACE ophthalmic solutions.

Formulation Grid#1 tested the following variables given in (a)-(e). The formulations were prepared in a nitrogen-flushed glove box and sterile filtered. All formulations were tested under accelerated conditions at 57° C. and tested by HPLC for assay and impurities at T=0, 3.5 days and 7 days. A total of 19 formulations were tested in Grid#1.

-   (a) Effect of pH: Formulations were prepared at pH 3.5, 4 and 5, and     compared with the control formulation at pH 4.5, As shown in FIG. 6     , the rate of degradation of LACE was equivalent at all pH levels in     the range 3.5-5. -   (b) Effect of Alanine: The role of alanine in the formulation was     deduced, by comparison of rates of degradation with the original     formulation (control). As shown in FIG. 6 , the absence of alanine     appeared to accelerate the rate of degradation of LACE. Thus,     Alanine is a critical excipient in EV06 Ophthalmic formulations. -   (c) Effect of Benzalkonium Chloride and Glycerin: it was     hypothesized that peroxides contained in glycerin can catalyze     oxidation similarly, it was hypothesized that BAK could destabilize     the drug substance, due to free radical scission and subsequent     oxidation. As seen in FIG. 7 , the benzalkonium chloride-free     formulation was substantially more stable than the control. The     glycerin-free prototype was also more stable than the control.     Additionally, sodium chloride added into the formulation (instead of     glycerol, to adjust osmolality) appeared to have a destabilizing     effect (also shown in FIG. 7 ) In another experiment with various     combinations of glycerin, sodium chloride, sulfite and pH with all     variations being benzalkonium chloride-free, it was remarkable that     all of the benzalkonium chloride-free formulations were more stable     than the control (FIG. 5 ). The experiments in FIGS. 7 and 9     demonstrate that eliminating benzalkonium chloride in LACE may be a     method to stabilize the formulation. For EV06 Ophthalmic     compositions, minimizing benzalkonium chloride content to 50 ppm may     have a major stabilizing factor. Sodium chloride demonstrated a     destabilizing effixt, thus glycerol was deemed more suitable as a     tonicity agent in final EV06 compositions. -   (d) Effect of Sulfite: Various experiments were performed with     sulfite (FIG. 8 ), with combinations of various levels of sulfite.     Sulfite was added to the formulation as an anti-oxidant (FIG. 8 ),     at various pH levels (4, 4.5) and concentrations. The presence of     sulfite did not appear to substantially improve the stability the     LACE. It was not clear if a deleterious effect was present, since     0.1% sulfite in the formulation was equivalent to the control. -   (e) Effect of glycerin: The effect of glycerin was investigated in     various formulation combinations, by the systematic elimination of     glycerin. As shown in FIGS. 7 and 10 , ⁻the glycerin-free     combinations appeared to be more stable than control. However, due     to the high destabilizing effect of sodium chloride, glycerin was     selected as the critical excipient for tonicity adjustment. -   (f) Effect of Buffer: Various buffered compositions were tested.     Acetate buffer and acetate +boric acid appeared to stabilize the     formulation.

Experimentals

-   a) HPLC Method Setup: The HPLC assay consisted of a 50 minute mobile     phase gradient made up of (A) 0.05M sodium phosphate monobasic,     0.005M 1-heptane sulfonic acid sodium salt, 0.2% v/v triethylamiue,     adjusted to pH 4.5 with phosphoric acid; and (B) acetonitrile. The     analytical column used is a YMC Pack ODS AO (4.6×250 mm, 5 μm, 120     Å), P/N AQ125052546WT; the analytical detection wavelength is 225     nm.

b) Formulations

Formulations were prepared with extensive care to ensure that the LACE API was not exposed to oxygen or heat. The API was aliquotted into clean glass vials under an inert N₂ atmosphere inside of glove bag, and stored wrapped in tinfoil in a −20° C. freezer until use. The formulations were prepared with high purity excipients, and sterile glassware. All excipients were pre-prepared in stock solutions and were mixed together before the addition of API & final pH adjustments. The formulations are tabulated in Appendix A.

II. RESULTS AND DISCUSSION

FIG. 6 is a plot of %API versus time at 57° C. (over T=0, 3.5 days and 7 days), systematically comparing formulations that were prepared at pH 3.5. 4, 4.5 (original), 5 and control without alanine. Even at T=0, the formulation without alanine had degraded considerably in API content. As seen in FIG. 6 , the formulations were equivalent under these conditions at pH 3.5-5.

FIG. 7 is a plot of formulations comparing the following variables: (a) Control (original) versus Control+025% sodium chloride, Control 0.25% sodium chloride without glycerin, (h) Control (original) versus control without henzalkonium chloride, (c) Control (original) versus original formulation without glycerin.

As seen in FIG. 7 , addition of sodium chloride to the original formulation did not stabilize the formulation.

FIG. 8 shows the effect of sulfite on LACE stability at 57° C. Sulfite-containing formulations were prepared at concentrations 0.05% sulfite and 0.1% sulfite at 4 and 4.5. Addition of sulfite did not stabilize the original formulation.

FIG. 9 further explores the potentially stabilizing effect of eliminating benzalkonium chloride. Formulation variations without henzalkonium chloride were superior to the control original formulation (pH 4.5). Formulation variations were BAC-free compositions at pHs 4, 4.5, no glycerin/no BAC+0.9% sodium chloride, no BAC+0.05% sulfite at pHs 4 and 4.5.

FIGS. 7 and 10 compare the effect of glycerin, in various compositions, as a function of pH, sulfite and sodium chloride. The no-glycerin, no-BAC formulation in the presence of sodium chloride and sulfite and the no-glycerin with BAC formulation were superior to the original formulation.

FIG. 11 explored the use of various buffered compositions on LACE stability. The original formulation (pH 4.5) was compared with acetate buffer compositions and borate at pH 7.5. Sodium edetate added as an anti-oxidant did not stabilize the formulation. Acetate buffer and acetate buffer plus boric acid appeared to be superior to the control formulation.

To summarize, elimination of benzalkonium chloride appeared to enhance stability consistently. Elimination of glycerol may be a positive step as well. Glycerol is known to have residual presence of formaldehyde which occasionally leads to degradation of API. Interestingly, addition of edetate or sulfite did not have a positive effect. Another anti-oxidant such as sodium ascorbate may have a positive effect.

TABLE 4 Compatibility Experiment Formulations Formulation # 1 grams grams Act. Ingredient Desired % needed used w/w % Lipoic Acid Choline 1 0.2 0.1849 0.9253 Ester (LACE) Alanine 0.5 0.1 2.0254 0.5068 Glycerine 0.1 0.02 0.401 0.0996 Benzalkonium 0.01 0.002 0.0378 0.0094 Chloride Ultrapure Water 75 15 12.338 61.7409 (1st addition) 1N NaOH Used to adjust to desired pH 0.0815 0.0143 1N HCl before final water addition Ultrapure Water qs qs 4.9149 24.5948 (2nd addition) Total 100 20 19.9835 Desired pH Final pH mOsm/L 4.5 4.55 Desired % grams grams Act. Ingredient w/w needed used w/w % Formulation # 2 Lipoic Acid Choline 1 0.0 0.1977 0.9923 Ester Alanine 0 0.02 0 0.0000 Glycerine 0.1 0.002 0.4009 0.0998 Benzalkonium 0.01 0 0.0386 0.0097 Chloride Ultrapure Water 75 15 14.4079 72.3176 (1st addition) 1N NaOH Used to adjust to desired pH 0.1185 0.0209 1N HCl before final water addition Ultrapure Water qs qs 4.7595 23.8894 (2nd addition) Total 100 20 19.9231 Desired pH Final pH mOsm/L 4.5 4.48 Formulation # 3 Lipoic Acid Choline 1 0.2 0.1993 0.9935 Ester Alanine 0.5 0.1 2.0227 0.5042 Glycerine 0.1 0.02 0.4031 0.0997 Benzalkonium 0.01 0.002 0.0409 0.0102 Chloride Ultrapure Water 75 15 12.414 61.8862 (1st addition) 1N NaOH Used to adjust to desired pH 0.0653 0.0114 1N HCl before final water addition Ultrapure Water qs qs 4.9141 24.4977 (2nd addition) Total 100 20 20.0594 Desired pH Final pH mOsm/L 3.5 3.59 Formulation # 4 Lipoic Acid Choline 1 0.2 0.2036 1.0357 Ester Alanine 0.5 0.1 2.021 0.5141 Glycerine 0.1 0.02 0.4012 0.1013 Benzalkonium 0.01 0.002 0.0402 0.0102 Chloride Ultrapure Water 75 15 12.3097 62.6215 (1st addition) 1N NaOH Used to adjust to desired pH 0.0289 0.0052 1N HCl before final water addition Ultrapure Water qs qs 4.6527 23.6691 (2nd addition) Total 100 20 19.6573 Desired pH Final pH mOsm/L 4 4.07 grams grams Act. Ingredient Desired % needed used w/w % Formulation # 5 Lipoic Acid Choline 1 0.2 0.2368 1.1813 Ester Alanine 0.5 0.1 2.0239 0.5048 Glycerine 0.1 0.02 0.4016 0.0994 Benzalkonium 0.01 0.002 0.041 0.0102 Chloride Ultrapure Water 75 15 12.3029 61.3746 (1st 1N NaOH Used to adjust to desired pH 0.0129 0.0023 1N HCl before final water addition Ultrapure Water qs qs 5.0265 25.0753 (2nd Total 100 20 20.0456 Desired pH Final pH mOsm/L 5 5.01 Formulation # 6 Lipoic Acid Choline 1 0.2 0.2013 1.0040 Ester Alanine 0.5 0.1 2.0216 0.5041 Sodium Chloride 0.25 0.05 0.5282 0.2635 Glycerine 0.1 0.02 0.4025 0.0996 Benzalkonium 0.01 0.002 0.04 0.0100 Chloride Ultrapure Water 75 15 11.8086 58.8963 (1st addition) 1N NaOH Used to adjust to desired pH 0.0208 0.0036 1N HCl before final water addition Ultrapure Water qs qs 5.0268 25.0716 (2nd addition) Total 100 20 20.0498 Desired pH Final pH mOsm/L 4 4.01 Formulation # 7 Lipoic Acid Choline 1 0.2 0.2004 0.9999 Ester Alanine 0.5 0.1 2.0209 0.5042 Sodium Chloride 0.9 0.18 1.8409 0.9186 Glycerine 0 0 0 0.0000 Benzalkonium 0.01 0.002 0.0402 0.0100 Chloride Ultrapure Water 75 15 10.9219 54.4961 (1st addition) 1N NaOH Used to adjust to desired pH 0.009 0.0016 1N HCl before final water addition Ultrapure Water qs qs 5.0083 24.9895 (2nd addition) Total 100 20 20.0416 Desired pH Final pH mOsm/L 4 4.12 Formulation # 8 Lipoic Acid Choline 1 0.2 0.1956 0.9784 Ester Alanine 0.5 0.1 2.022 0.5057 Sodium Sulfite 0.05 0.01 0.2068 0.0517 Glycerine 0.1 0.02 0.4005 0.0994 Benzalkonium 0.01 0.002 0.0401 0.0100 Chloride Ultrapure Water 75 15 12.16 60.8219 (1st addition) 1N NaOH Used to adjust to desired pH 0.1008 0.5042 1N HCl before final water addition Ultrapure Water qs qs 4.867 24.3438 (2nd addition) Total 100 20 19.9928 Desired pH Final pH mOsm/L 4 4.03 Formulation # 9 Lipoic Acid Choline 1 0.2 0.2205 1.0953 Ester Alanine 0.5 0.1 2.027 0.5035 Sodium Sulfite 0.05 0.01 0.2062 0.0512 Glycerine 0.1 0.02 0.3996 0.0985 Benzalkonium 0.01 0.002 0.0392 0.0097 Chloride Ultrapure Water 75 15 12.1982 60.5944 (1st addition) 1N NaOH Used to adjust to desired pH 0.0995 0.4943 1N HCl before final water addition Ultrapure Water qs qs 4.9407 24.5429 (2nd addition) Total 100 20 20.1309 100.0000 Desired pH Final pH mOsm/L 4.5 4.03 Formulation # 10 Lipoic Acid Choline 1 0.2 0.1973 0.9873 Ester Alanine 0.5 0.1 2.0249 0.5066 Sodium Sulfite 0.1 0.02 0.4136 0.1035 Glycerine 0.1 0.02 0.4013 0.0996 Benzalkonium 0.01 0.002 0.041 0.0102 Chloride Ultrapure Water 75 15 11.9708 59.9031 (1st addition) 1N NaOH Used to adjust to desired pH 0.1921 0.9613 1N HCl before final water addition Ultrapure Water qs qs 4.7426 23.7325 (2nd addition) Total 100 20 19.9836 Desired pH Final pH mOsm/L 4.5 4.35 Formulation # 11 Lipoic Acid Choline 1 0.2 0.2097 0.9746 Ester Alanine 0.5 0.1 2.0437 0.4749 Sodium Chloride 0.9 0.18 1.8022 0.8376 Sodium Sulfite 0.05 0.01 0.2116 0.0492 Glycerine 0 0 0 0.0000 Benzalkonium 0.01 0.002 0.0384 0.0089 Chloride Ultrapure Water 75 15 17.0628 79.3025 (1st addition) 1N NaOH Used to adjust to desired pH 0.1477 0.0241 1N HCl before final water addition Ultrapure Water qs qs (2nd addition) Total 100 20 21.5161 Desired pH Final pH mOsm/L 3.5 3.52 Formulation # 12 Lipoic Acid Choline 1 0.2 0.1953 0.9703 Ester Alanine 0.5 0.1 2.0402 0.5068 Sodium Chloride 0.9 0.18 1.7998 0.8943 Sodium Sulfite 0.05 0.01 0.2135 0.0531 Glycerine 0 0 0 0.0000 Benzalkonium 0.01 0.002 0.0423 0.0105 Chloride Ultrapure Water 75 15 15.6996 78.0031 (1st addition) 1N NaOH Used to adjust to desired pH 0.1362 0.0238 1N HCl before final water addition Ultrapure Water qs qs (2nd addition) Total 100 20 20.1269 Desired pH Final pH mOsm/L 4 4 Formulation # 13 Lipoic Acid Choline 1 0.2 0.1997 0.9946 Ester Alanine 0.5 0.1 2.0386 0.5077 Sodium Chloride 0.9 0.18 1.8033 0.8982 Sodium Sulfite 0.05 0.01 0.2152 0.0536 Glycerine 0 0 0 0.0000 Benzalkonium 0.01 0.002 0.0397 0.0099 Chloride Ultrapure Water 75 15 15.6858 78.1239 (1st addition) 1N NaOH Used to adjust to desired pH 0.0958 0.0168 1N HCl before final water addition Ultrapure Water qs qs (2nd addition) Total 100 20 20.0781 Desired pH Final pH mOsm/L 4.5 4.48 Formulation # 14 Lipoic Acid Choline 1 0.2 0.1976 0.9873 Ester Alanine 0.5 0.1 2.0425 0.5103 Glycerine 0.1 0.02 0.4158 0.1031 Benzalkonium 0 0 0 0.0000 Chloride Ultrapure Water 75 15 17.3172 86.5237 (1st addition) 1N NaOH Used to adjust to desired pH 0.0413 0.0073 1N HCl before final water addition Ultrapure Water qs qs (2nd addition) Total 100 20 20.0144 Desired pH Final pH mOsm/L 4 4.05 Formulation # 15 Lipoic Acid Choline 1 0.2 0.215 1.0757 Ester Alanine 0.5 0.1 2.0453 0.5117 Glycerine 0.1 0.02 0.4078 0.1012 Benzalkonium 0 0 0 0.0000 Chloride Ultrapure Water 75 15 17.2993 86.5545 (1st addition) 1N NaOH Used to adjust to desired pH 0.0192 0.0034 1N HCl before final water addition Ultrapure Water qs qs (2nd addition) Total 100 20 19.9866 Desired pH Final pH mOsm/L 4.5 4.52

Example 6: Correlation of Ocular Irritation with Percent Micellar LACE Species

FIGS. 12A and 12B generally provide a snapshot of the correlation of irritation to the micellar LACE species over a number of batches compounded.

Example 7 Method of Adjustment of Osmolality with Glycerol

-   The requisite osmolality range for drug-containing formulations and     placebo is 280-320 mOsm/kg. Preferably, all LACE formulations need     to he within 290-310 mOsm/Kg. -   Since LACE has contributions to osmolality, each formulation will     have varying concentrations of glycerol to achieve the requisite     osmolality.

I. Summary: Final Adjusted Compositions

TABLE 4 Final Compositions of EV06 Ophthalmic Solutions with Adjusted Glycerol Concentrations Benzalkonium Actual Total LACE Glycerol Alanine Chloride Osmolality Conc. (%) (%) (%) (mOsm/kg) 0% 2.07% 0.5% 0.005% 295 1% 1.56% 0.5% 0.005% 299 2% 1.07% 0.5% 0.005% 296 2.5%  0.80% 0.5% 0.005% 302 3.0%  0.53% 0.5% 0.005% 308

II. Experimental Detail:

A. Glycerol-containing Placebos

A series of placebos was prepared. All placebos, and the LACE-containing solutions that were subsequently prepared, contained the following, with varying amounts of Glycerol:

-   0.5% (5 mg/g) Alanine -   0.005% (0.05 mg/g) Benzalkonium Chloride -   Small amounts of 1N Sodium Hydroxide, 1N Hydrochloric Acid, to     adjust pH to 4.5 -   Water for Inhalation (added for final weight)

TABLE 5 Glycerol-containing Placebo (Effect of Glycerol Concentration) Glycerol Percent Osmolality (mOsm/kg) 0.5% 114 1.0% 172 1.5% 233 2.0% 292 2.5% 354

B. LACE-Containing Formulations

Based on the standard curve shown in FIG. 12C and the data from fommlations that showed an additional 44-55 mOsm/kg (average of 48 mOsm/kg) for every 1% LACE, a series of solutions was prepared to confirm the actual osmotic contribution of LACE. The target for Total Osmolality was 300 mOsm/kg.

TABLE 6 Glycerol Concentrations for EV06 Compositions Target Actual Total LACE Osmolality Glycerol % for Osmolality Conc. w/o LACE target Osm. (mOsm/kg) 0% 300 2.06% 295 1% 250 1.64% 308 2% 203 1.25% 324

These data indicate that the effect of LACE on osmolality is somewhat greater than expected, on the order of 57-60 mOsm/kg for every 1%. Accordingly, a full series of solutions was prepared with slightly altered target osmolalities for the solutions without LACE, and therefore different target glycerol contents. All solutions were prepared using the same Alanine/Benzalkonium Chloride, pH 4.5 stock solution used in the placebos, so that the final composition was consistently:

-   0.5% (5 mg/g) Alanine -   0.005% (0.05 mg/g) Benzalkonium Chloride -   Small amounts of 1N Sodium Hydroxide, 1N Hydrochloric Acid, to     adjust pH to 4.5 -   Water for Inhalation (added to final weight of 5.0 g per     formulation)

TABLE 7 Adjustment of Osmolality of EV06 Compositions Actual Target Glycerol % Actual Total LACE Conc. Osmolality used for Osmolality (Actual %) w/o LACE target Osm. (mOsm/kg) 0% 300 2.06% 295  1% (1.01%) 242 1.56% 299  2% (2.04%) 180 1.06% 296 2.5% (2.51%) 150 0.80% 302 3.0% (2.94%) 120 0.56% 308

C. Sterile Preparations

Based on these experimental results, sterile filtered 10.0-g hatches of each formulation were prepared, with the following target compositions, and packaged into sterile eye dropper bottles (2mL per bottle):

TABLE 8 Final Composition Grid of EV06 Compositions LACE Benzalkonium Conc. Glycerol (%) Alanine (%) Chloride (%) 0% 2.07% 0.5% 0.005% 1% 1.56% 0.5% 0.005% 2% 1.07% 0.5% 0.005% 2.5%  0.80% 0.5% 0.005% 3.0%  0.53% 0.5% 0.005%

Example 8 Method of Preparation of LACE Chloride Pharmaceutical Compositions

A method of preparing LACE pharmaceutical composition is as follows:

-   At room temperature, Water for Injection (WFI) at 80% of batch     weight is added to glass compounding vessel. The water is purged     with nitrogen to achieve: S10 ppm oxygen. -   Stepwise, alanine, glycerin, and BAK, are added, and mixed until     dissolved.

The pH is adjusted to 4.4-4.6 with HCl or NaOH.

-   LACE is ground in a mortar and pestle under nitrogen to de-chimp and     slowly added while mixing. -   Deoxygenated Water for Injection is added to achieve final batch     target weight. -   Batch is mixed for a total of 8 hours to ensure complete dispersion     and dissolution. -   The pH may be adjusted to 4.4-4.6 with NaOH or HCl if needed. -   Osmolality may adjusted to 290-310 with glycerol if needed.

After 8 hours of mixing, EV06 bulk drug product solution is aseptically filtered through a capsule SHC 0.5/0.2 μm sterilizing filter into a holding bag.

-   The bulk product solution in the holding bag is kept at 5° C. by     refrigeration or ice bath. -   Filter bubble point test is performed to ensure the integrity of the     filter.

Sterile filtered bulk solution is aseptically transferred to the Class 100 room and filled into pre-sterilized bottles.

-   Sterile tips and caps are applied to the bottles under nitrogen     overlay. -   Sealed bottles are transferred to trays, which are bagged with a     nitrogen purge and immediately transferred to 5° C. storage.

Example 9 Stability Studies of LACE Chloride Formulations

Early formulation prototypes contained sodium edetate and 0.01% benzalkonium chloride. Stability studies with and without these excipients demonstrated that sodium edetate did not stabilize LACE. Presence of excess benzalkonium chloride slightly destabilized the drug. Thus, the final formulation contains no sodium edetate and 0.005% benzalkonium chloride. Through microbiological testing, 0.004% benzalkonium chloride in the current formulation composition was shown to be effective as a preservative in the drug product.

in an effort to stabilize the drug formulation further, systematic stability studies (5° C., 25° C. and 40° C.) on mid-scale R&D batches were undertaken with bottled EV06 Ophthalmic Solution in the presence and absence of oxygen scavenging packets contained in zip-lock, vapor impermeable foil pouches. Bottles of product stored at 5° C. in the presence of an oxygen scavenging packet sealed in re-sealable foil pouches demonstrated stability at 12 months.

Additional precautions were implemented throughout the development process to stabilize the final formulation from degradation due to exposure to environmental oxygen and non-refrigerated conditions. Handling of the drug substance under nitrogen (exclusion of oxygen and minimization of moisture) and compounding under a nitrogen blanket were implemented to minimize exposure to oxygen. After compounding, the product is filled into a vapor impermeable holding bag and stored under refrigerated conditions until bottling ensues. The holding bag containing the bulk solution is kept cold during filling. A nitrogen blanket is placed over the drug solution in each bottle, to minimize oxygen exposure.

TABLE 9 Supporting Stability- Batch ECV-12 JUN. 2014-120-04 Stability Table for EV06 Ophthalmic Solution, 3.0% Container Polyethylene dropper bottle, 6 cc Secondary Container: Foil Pouch Closure: Dropper Tip and Cap Oxygen Adsorbent: Oxygen Adsorbent Packet present Acceptance Test Method Criteria T = 0 2 Weeks 1 Month 5^(°) C. Appearance ATM-1095 Clear, pale yellow Conforms Conforms Conforms to yellow solution essentially free of foreign or particulate matter Assay, ATM-1405 90.0-110.0% of 101.1% 107.1% 106.7% LACE Label Claim Related ATM-1405 Individual RRT 0.57: 0.05% RRT 0.58: 0.17% RRT 0.59: 0.21% Compounds Report 2: 0.05% RRT 0.59: 0.21% RRT 0.63: 0.09% RRT 0.64: 0.09% (% area) RRT 0.64: 0.13% RRT 0.66: 0.17% RRT 0.67: 0.15% Total Report RRT 0.83: 0.06% RRT 0.83: 0.06% RRT 0.83: 0.06% RRT 1.23: 0.14% RRT 1.23: 0.16% RRT 1.18: 0.05% Total: 0.8% LA: 0.06% RRT 1.20: 0.10% Total: 0.7% LA: 0.10% Total: 0.8% Assay, ATM-1406 Report 0.0447 mg/mL 0.0443 mg/mL 0.0446 mg/mL preservative pH USP <791> Report 4.6 4.5 4.5 Osmolality USP <785> 250-350 mOsm/kg 262 mOsm/kg 263 mOsm/kg 263 mOsm/kg 25° C. ± 5° Appearance ATM-1095 Clear, pale yellow Conforms Conforms Conforms to yellow solution essentially free of foreign or particulate matter Assay, ATM-1405 90.0-110.0% of 101.1% 107.3% 107.0% LACE Label Claim Related ATM-1405 Individual RRT 0.57: 0.05% RRT 0.56: 0.05% RRT 0.59: 0.27% Compounds Report 2: 0.05% RRT 0.59: 0.21% RRT 0.58: 0.22% RRT 0.64: 0.12% (% area) RRT 0.64: 0.13% RRT 0.63: 0.12% RRT 0.67: 0.18% Total Report RRT 0.67: 0.21% RRT 0.66: 0.21% RRT 0.33: 0.07% RRT 0.83: 0.06% RRT 0.83: 0.07% RRT 1.20: 0.16% RRT 1.23: 0.14% RRT 1.23: 0.09% RRT 1.85: 0.09% Total: 0.8% RRT 1.25: 0.07% LA: 0.65% LA: 0.35% Total: 1.5% Total: 1.2% Assay, ATM-1406 Report 0.0447 mg/mL 0.0445 mg/mL 0.0447 mg/mL preservative pH USP <791> Report 4.6 4.4 4.4 Osmolality USP <785> 250-350 mOsm/kg 262 mOsm/kg 264 mOsm/kg 264 mOsm/kg Test 2 Month 3 Month 6 Month 12 Month 5^(°) C. Appearance Conforms Conforms Conforms Conforms Assay, 98.9% 98.1% 95.0% 94.7% LACE Related RRT 0.61: 0.10% RRT 0.65: 0.08% RRT 0.61: 0.34% RRT 0.59: 0.07% Compounds RRT 0.66: 0.07% RRT 0.67: 0.15% RRT 0.67: 0.21% RRT 0.63: 0.12% RRT 0.86: 0.07% RRT 0.71: 0.12% RRT 0.69: 0.23% RRT 0.68: 0.09% RRT 1.21: 0.08% RRT 0.74: 0.16% RRT 0.84: 0.06% RRT 0.72: 0.12% RRT 1.27: 0.09% RRT 0.83: 0.05% RRT 1.14: 0.08% RET 0.89: 0.05% LA: 0.17% RRT 1.09: 0.07% RRT 1.20: 0.10% RRT 1.38: 0.06% Total: 0.6% RRT 1.15: 0.09% LA: 0.32% RRT 1.42: 0.09% LA: 0.22% Total: 1.3% LA: 0.38% Total: 0.9% Total: 1.0% Assay, 0.0447 mg/mL 0.0440 mg/mL 0.0441 mg/mL 0.0504 mg/mL preservative pH 4.5 4.5 4.4 4.3 Osmolality 262 mOsm/kg 262 mOsm/kg 261 mOsm/kg 255 mOsm/kg 25° C. ± 5° Appearance Conforms Conforms Conforms Assay, 97.2% 98.9% 87.1% LACE Related RRT 0.59: 0.18% RRT 0.66: 0.28% RRT 0.61: 0.58% Compounds RRT 0.66: 0.09% RRT 0.72: 0.15% RRT 0.69: 0.30% RRT 0.86: 0.07% RRT 0.74: 0.12% RRT 0.84: 0.06% RRT 1.21: 0.08% RRT 0.83: 0.06% RRT 1.14: 0.08% RRT 1.27: 0.19% RRT 1.09: 0.07% RRT 1.20: 0.29% LA: 0.94% RRT 1.15: 0.20% RRT 1.26: 0.51% Total: 1.6% RRT 1.21: 0.27% RRT 1.34: 0 18% RRT 1.27: 0.09% LA: 1.18% LA: 1.05% Total: 3.2% Total: 2.4% Assay, 0.0438 mg/mL 0.0435 mg/mL 0.0462 mg/mL preservative pH 4.3 4.2 4.1 Osmolality 263 mOsm/kg 261 mOsm/kg 259 mOsm/kg

Related Compounds: LA=<-R-Lipoic Acid (USP Standard) Example 10 Formulation Studies to Disrupt Micellization of LACE Iodide Summary of Experiments:

In experiments where Sodium Chloride was either added to an existing LACE-Iodide formulation, or a solution containing Sodium Chloride was used to dissolve the LACE-Iodide API, the “associative species” peak was not significantly decreased.

In experiments where a co-solvent such as Ethanol or Propylene Glycol was used to suspend the API prior to addition of an aqueous vehicle, there was a very significant reduction in the percentage of the associative species. Addition of an organic solvent to an existing formulation also decreased the associative species peak, to a lesser extent.

These results point to formulation strategies that can interfere with the hydrophobic interaction between LACE molecules as a means of controlling the associative species.

Background

The “associative species” that we have observed by RP-HPLC, which represents a large percentage of the API in the various formulated hatches prepared using the LACE-Iodide, has been hypothesized to he a micellar aggregate. This is based in part on the surfactant-like structure of the LACE molecule, and the ability to dissipate this species by dilution or additional stirring in the case of the LACE-Chloride.

In the literature, Sodium Chloride is a known micelle disruptor. Therefore a series of experiments was undertaken to test whether this “associative species” could he dissipated by addition of sodium chloride, or other ingredients that would be expected to disrupt the associative species by other mechanisms, such as hydrophobic interactions.

Results

As a first test of this hypothesis, an existing formulation (batch FK-LACE-02-15) known to exhibit a large “associative species” peak was mixed with solutions containing various levels of Sodium Chloride (NaCl). The final diluted LACE concentration was targeted to the level appropriate for RP-HPLC analysis (12.8 mg/mL of LACE-Iodide).

Table 10 shows the key results of this set of experiments, which did not demonstrate any significant change in ⁻the level of associative species over time, even at levels of salt (NaCl) far above what would be acceptable in the eye (due to very high osmolality).

Diluting the formulation with Acetonitrile to the same final LACE-Iodide concentration, resulting in —33% Acetonitrile overall, led to a modest decrease in the level of associative species, from a range of 36-40% down to 26% in 4 hours.

TABLE 10 Addition of Salt or Organic Solvent to Batch FK-LACE-02-15 Condition (ingredient listed % Associative Species at: with final concentration) T = 0 4 hou s 24 hours Formulation as is 39.0% (dil. to 12.8 mg/g) Form. + 0.9% NaCl 37.1% 38.3 37.2% Form. + 1.8% NaCl 35.9% (not meas.) 36.4% Form. + 3.6% NaCl 36.2% 36.0 (not meas.) Formulation + 33.4% 25.8 23.7% 33% Acetonitrile

In the next set of experiments, the LACE-Iodide API was dissolved in various ways to determine whether these conditions could prevent the initial formation of the associative species, and therefore eliminate the seed that allowed further growth of this species over time. The conditions tested were:

Dissolution in pH 4.5 buffer (0.5% Alanine, 0.005% BAK) containing 1.8% NaCl.

Dissolution in Ethanol—API did not dissolve in neat Ethanol, forming a suspension. About 22% by volume of the aqueous pH 4.5 buffer was added, leading to nearly complete dissolution of the API, with some heating at 37° C.

Dissolution/suspension in Propylene Glycol, followed by dissolution in the aqueous pH 4.5 buffer. Propylene Glycol was added first, and represented 10% by weight of the final solution.

Dissolution in pH 4.5 buffer containing 0.6% NaCl and 1.5% Propylene Glycol (PG). This was intended to test whether disruption of charge-charge interactions (by NaCl) and hydrophobic interactions (by PG) would have a synergistic effect, using concentrations of each that would he reasonable in terms of osmolality,

As shown in Table 10, the Ethanol and Propylene Glycol experiments were successful in eliminating or significantly reducing the associative species present at T=0, relative to the other dissolution experiments. Note that the solution was added to the API powder, rather than the formulation practice of adding API to solution, which may explain why T=0 was high in some of these cases, but not on the day the formulated hatches were prepared.

TABLE 10 Experiments with Direct Dissolution of LACE-Iodide API (Lot# 011510) Dissolution Method % Associative Species at T0 Buffer with 1.8% NaCl 34.7% Ethanol (78% final), 0.0% then Buffer (22%) Propylene Glycol (10%), 11.7% then Buffer (90%) Buffer with 0.6% NaCl, 1.5% PG 40.9%

Example 11 Formulation Studies with Cyclodextrins to Disrupt Micellization of LACE Iodide Hypothesis

Associative species can be mitigated by inclusion of excipients that interfere with hydrophobic interactions between LACE molecules.

Formulations containing Polypropylene Glycol, Dexolve-7 (Sulfobutylether-beta-cyclodextrin), or Hydroxypropyl-beta-cyclodextrin were prepared and analyzed for associative species and related substances.

TABLE 11 Formulation Studies to Prevent Miceliization of LACE Iodide in Solution Batch ID, Osmolality % Associative % Related % Oxo-LACE Composition Batch Size (mOsm/kg) Species at 5C Substances Species FK-LACE-02-09 160 g 278 32.9% (4 weeks) 1.33% 0.83% Control batch Same as LACE-Cl formulation FK-LACE-02-28 3 g 281 0.0% (24 h) TBD Not visible by 5.76% Dexolve RP-HPLC FK-LACE-02-29 3 g 299 0.0% (72 h) 6.69% 4.66% 5% PPG FK-LACE-02-32 25 g 279 4.5% (24 h) 0.94% 0.21% Same as Control 3.6% (96 h) FK-LACE-02-33 25 g 273 13.2% (24 h) 5.67% 5.15% 5% PPG 14.2% (96 h) FK-LACE-02-36 25 g 281 0.0% (72 h) 0.98% 0.09% 5.76% Dexolve FK-LACE-02-37 25 g  151* 0.0% (72 h) 0.81% 0.11% 5.0% HPCD % oxo-LACE species are shown at T = 0.

Example 12 Enhanced Stabilily in HP-B-CD/Lace-Iodide Formulations

These experiments demonstrate enhancement of stability achieved by HP-B-CD/Lace-Iodide formulation compared to non-HP-B-CD/Lace-Iodide formulation.

Experiment #1

Formulations were prepared that comprised 3% LACE-Iodide either with (16.1% HPBCD) or without Hydroxypropyl-B-cyclodextrin (HP-B-CD) at a 10-g scale. Both formulations contained 0.5% Alanine, pH 4.5, 50 ppm Benzalkonium Chloride, and Glycerol for osmolality adjustment and all solutions were at pH 4.2-4.5. In the formulation that contained HP-B-CD, the cyclodextrin was present in a 1.5:1 molar ratio, relative to the LACE concentration. The formulations were filtered through a 0.2-μm PVDF membrane, and 5 mL of each formulation was filled into a 10-mL LDPE eye dropper bottle, and then blanketed with nitrogen before the dropper tip was inserted and the bottle capped. The eye-dropper bottle was not barrier pouched at the time of filling.

The eve dropper bottles with the two formulations were stored at 25° C. in a temperature-controlled incubator, and 0.5 mL (about 10 drops) sampled at each time point for analysis of related substances (by HPLC). The nitrogen blanket was not replenished, so some air got into the bottle with each sampling. This experiment was an early investigation of stability at room temperature (25±0.1° C.) with no protection from oxygen with continued sampling.

FIG. 18 shows a time course of the increase of the oxidized species of LACE over 20 days at 25C with repeated sampling (square: LACE-I, 3% formulation, 16.1% HP-B-CD; diamond: LACE-I, 3% formulation, no HP-B-CD). The sampling time-points were T-0, I day, 2 days, 8 days, 12 days and 17 days).

These data (FIGS. 18 and 19 ) demonstrated that the cyclodextrin protected LACE from oxidation both initially, resulting in lower amounts of oxidized API during preparation, as well as under an accelerated stress condition with increasing amounts of oxygen present. The formulation with HP-B-CD remained within the specification of ≤2.0% total impurities through 17 days (not including Lipoic Acid) under these conditions. At the end of 20 days, lipoic acid concentration was —0.20%.

Example. 13 Comparative Stability between LACE-Chloride Clinical Formulation and LACE-Iodide HP-B-CD

For the stability studies on both the clinical LACE-Chloride and the prototype LACE-Iodide formulation with a 1:1 molar ratio of HP-B-CD to LACE, the formulations were filtered, filled into LDPE eye dropper bottles, blanketed with nitrogen, and then placed inside barrier foil pouches with an oxygen scavenger. It is likely that some oxygen was still present in the pouch to start. After the first time point following T=0, however, the rise in oxidized LACE species stops, even at elevated temperatures, likely due to depletion of the remaining oxygen (FIG. 20 ). The rate of increase of oxidized species for LACE-Chloride was slightly higher at 25C than at 5C, though not significantly.

The prototype LACE-Iodide formulation containing HP-B-CD shows lower levels of oxidized LACE to start (˜0.11% for LACE-Iodide, as opposed to 0.3% for LACE-Chloride), despite being prepared without any nitrogen blanket during dissolution of the API. For the clinical LACE-Chloride formulation, the solution was deoxygenated and a nitrogen blanket was maintained during dissolution.

In addition, after being blanketed with nitrogen and placed inside the pouch, the prototype LACE-Iodide formulation displayed a much smaller rise in the total Oxidized LACE percentage before leveling off. The extent of the initial rise was dependent on temperature for both formulations. This allowed for estimation of the activation energy for each formulation by ,Arrhenius modeling. For the prototype LACE-Iodide formulation with HP-B-CD, the activation energy was more than tripled relative to the original LACE-C1 formulation (FIG. 21 ), further indicating that HP-S--CD stabilizes LACE against oxidation.

Formulation Activation Energy Clinical LACE-Cl  9.9 kJ/mol Prototype LACE-I w/HPbCD 33.2 kJ/mol

Activation energies for the hydrolysis mechanism of LACE degradation, which results in growth of Lipoic Acid, were also calculated from the stability data (FIG. 22 ). In contrast to the oxidation mechanism, the activation energies for hydrolysis for both the LACE-C1 formulation and the LACE-I fommlation were similar (65.6 kJ/mol and 69.4 kJ/mol, respectively) (FIG. 21 ), indicating that the cyclodextrin has no significant impact on hydrolysis.

Example 14 Corneal Permeability Studies of LACE-Chloride and LACE-Iodide

A critical question was whether the drug formulated with hydroxypmpyl beta cyclodextrin (HP-B-CD) permeated corneal tissue adequately and was accessible to corneal esterases to release the active drug, lipoic acid. As mentioned earlier, Lipoic Acid is the active drug for this indication: Presbyopia.

The experiments below tested: (a) the permeability of lipoic acid choline ester (LACE) through bovine calf cornea via LACE-Iodide formulations containing hydroxypropyl-B-cyclodextrin (HP-B-CD) at different concentrations, and (b) comparative permeability of LACE-Chloride versus LACE-Iodide. The experiments were performed using a Franz Cell Diffusion apparatus shown in FIG. 23 .

LACE is delivered from these formulations as one of two salts: LACE-chloride and LACE-iodide. LACE is the pro-drug, traveling through the corneal barrier before being hydrolyzed into lipoic acid, the active drug, through the action of ocular esterases and through passive hydrolysis of the drug compound at physiological conditions. Therefore, both LACE and lipoic acid concentrations were assayed at each time point to evaluate permeability.

Compositions for Corneal Permeability, by Study #

Study 1 Study 2 Study 3 Study 4 AC- ECV- AC- AC- AC- ECV- AC- FK- LACE- 23 Apr. 15- LACE- LACE- LACE- 23 Apr. 15- LACE- LACE- (% w/w) 03-33 112-08 03-36 03-39 03-39 112-08 03-33 02-32 LACE-I 1.92 1.5% 3.0 4.5 4.5 1.5% 1.92 1.92 LACE-Cl LACE-Cl HP-JJ-CD 6.88 — 10.75 16.12 16.12 — 6.88 — Alanine 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 BAK 0.005 0.005 0.005 0.005 0.005 0.005 0.005 0.005 Glycerol 1.1 1.37 0.6 0.0 0.0 1.37 1.1 1.38 WFI 89.6 96.6 85.15 78.88 78.88 96.6 89.6 96.2

Procedure:

-   a. 6 bovine eyeballs are dissected in a sterile laminar flow hood. -   b. The corneas are extracted from the eyeball, briefly rinsed in     sterile double-distilled water, and submerged in 3 mL of glutathione     buffer (0.1% glutathione, oxidized, 6 mM sodium phosphate, pH 7,     sterile-filtered) in a sterile culture dish. -   c. The corneas are kept at 5° C. and used within 24 hours of     excision. -   d. Six 5 mL Franz vertical diffusion cells are cleaned with     distilled water and isopropanol and air dried in a laminar flow     cabinet prior to set up. -   e. A small stir bar is placed within the receptor fluid chamber. The     bottle of receptor fluid (5 mM phosphate-buffered saline with 0.1%     Tween 20, pH 7.4, sterile-filtered) is tared on an analytical     balance, and 4.5 mL of it is added to each Franz cell. The exact     weight of the starting receptor fluid is recorded. -   f. The cornea is gently rinsed of glutathione buffer with receptor     fluid, and is placed on the donor pedestal. The donor chamber is     placed on top of the cornea, and the entire assembly is fastened to     the pedestal with a metal clip. At this point, 0.5 mL of additional     receptor fluid is added via the sampling arm, until the fluid level     reaches the point marked on the arm with a black line. The weight of     this addition is also recorded. -   g. The Franz diffusion apparatus is connected to a heater unit, and     the temperature is raised to 37° C. When that temperature is     reached, the formulation (“the donor solution”) is added to the     donor chamber. -   h. 0.2 mL of donor solution is added. Both the donor chamber and     sampling arm are covered by paraffin when not in use to prevent     evaporation. -   i. Sampling is done via Drummond pipet, and only through the     sampling arm. 200-300 μL of receptor fluid is sampled from each cell     at each time point. -   j. The sample is added to an amber glass HPLC vial with 0.3 mL glass     insert, and is weighed. The volume taken from the sampling arm is     replaced with fresh receptor fluid. -   k. When sampling, the fluid level was never allowed to fill below     the start of the sampling arm, such that air bubbles were introduced     to the receptor chamber. If the fluid had evaporated significantly     between two time points, a pre-sampling replacement was added and     recorded, and sampling proceeded as normal. -   l. The samples were stored at 5° C., until HPLC analysis of assay. -   m. Corneas were extracted with bead mill homogenization.

Study 1: The purpose of this study was to compare the permeability of AC-LACE-03-33, containing 1.92% LACE-Iodide, with ECV-23 Apr. 15-112-08, Demo #6 (Frontage, 1.5% LACE-Chloride), in order to evaluate the effects of HP-B-CD on the passage of LACE through the cornea. Given the difference in molecular weight between LACE-I and LACE-Cl, these were equivalent concentrations of LACE. Thus, a 1.5% LACE-Chloride was equivalent to a 1.92% LACE-Iodide formulation. No esterase inhibitor was used in the experiment.

The results from Study 1 (FIGS. 24 and 25 ) demonstrated that the majority of the drug product that permeated was lipoic acid, which had been hydrolyzed from LACE during passage through the cornea, or in the receptor solution prior to time point collection. The permeated species was almost entirely lipoic acid for the LACE-Iodide formulation, with somewhat more intact LACE permeated with the LACE-Chloride formulation. This is somewhat expected due to the larger ionic size and molecular weight of the LACE-Iodide molecule, compared to the LACE-Chloride molecule, possibly resulting in a longer residence time in the cornea and a higher degree of hydrolysis to lipoic acid. Permeates were analyzed immediately after collection after each sampling point. The overall percent of drug permeated was similar between LACE-I and LACE-Cl-containing formulations, at 3-7° (not including one high-permeation outlier for the LACE-D.

Study 2: The purpose of this study was to evaluate the permeability of two LACE-I formulations, with different concentrations of LACE-I: AC-LACE-03-36 (3% LACE-Iodide/10.7% HP-B-CD) and AC-LACE-03-39 (4.5% Lace-Iodide/16.1% HP-B-CD) (FIGS. 26 and 27 ).

The results from Study 2 showed that most of the permeated drug existed in the receptor fluid in its lipoic acid form, but in lower concentrations compared to the previous study, despite there being higher drug concentrations. A significant portion of the drug was contained within the corneal tissue due to the crop of thicker calf corneas (˜1.5-1.8 mm in Study 2, ˜0.6-0.8 mm in Study 1) available for this study. A range of 1-5% of the total amount of lipoic acid was extracted from the corneal tissue, with an average of 3.4% extracted from the corneas exposed to AC-LACE-03-36 (3.0% LACE-I/10.7% HP-B-CD) and 2.5% extracted from the corneas for AC-LACE-03-39 (4.5% LACE-I/16.1% HP-B-CD).

Study 3: This study investigated permeability between a LACE-Iodide formulation that contained HP-B-CD and a LACE-Chloride formulation that contained no HP-B-CD. The purpose of this study was to build on previous data obtained in Study 2, by examining the difference in LACE conical permeability between AC-LACE-03-39 (4.5% LACE-I/16.1% HP-B-CD) and ECV-23 Apr. 15-112-08 (1.5% LACE-Cl, no HP-B-CD) to further determine whether the concentration of LACE was an impediment to its permeation across the corneal layer.

Extraction of LACE/LA from the conical section of contact was done by bead mill homogenization, and revealed that a higher mass of Lipoic Acid was found in the corneal tissue exposed to AC-LACE-03-39 (4.5% LACE-I/16.1% HP-B-CD) upon conclusion of the study, although the increase in concentration within the corneas was significantly smaller than the increase in delivered API concentration (FIGS. 28 and 29 ). Therefore the highest dose of 4.5% LACE-I may not provide a significant advantage in terms of permeated drug.

Study 4: This study compared the effect of hydroxypropyl beta cyclodextrin on permeability, while keeping the LACE salt form constant. In this study, both cohorts were LACE-Iodide.

The formulations were FK-LACE-02-32 (1.92% LACE-I, no HP-B-CD) and AC-LACE-05-21B (1.92% LACE-I, 1 molar equivalent HP-B-CD (7.4%)). The purpose of this study was two-fold. The first objective was to directly compare two LACE-I solutions, of equal concentrations, such that HP-B-CD's impact on permeation would be directly examined. The second objective was to examine HP-B-CD's impact on retention of the drug product within the corneal tissue.

The data of this study indicates that HP-B-CD has no impact on conical retention of the drug—for both formulations, 7% of the total LA (lipoic acid) on average was extracted from the corneal sections (FIGS. 30 and 31 ).

In terms of permeation across the corneal layer, all 3 corneas for FK-LACE-02-32 showed permeation from 4-6 hours onward, while only 1 cornea for AC-LACE-05-2.1B showed permeation starting at the 4-hour time point. However, the average permeated drug product at 28 hours was similar, with 12.67±5.62% of total LA for FK-LACE-02-32 and 11.27±9.78% of total LA for AC-LACE-5-21B. The similarity in extracted corneal concentrations, as well as the similar average permeation at 28 hours shows that HP-B-CD is not an impediment toward LACE-I entering the corneal tissue.

All data assessed together, demonstrates that LACE-Iodide can be administered to the ocular surface with no impediment of transport due to its larger molecular size and the delivery system (HP-B-CD). Additionally, study results demonstrated efficient transport of LACE through the cornea at all concentrations investigated. Furthermore, high lipoic acid concentrations produced in the receptor fluid for LACE-Iodide/HP-B-CD concentrations demonstrated conversion of LACE to lipoic acid by corneal esterases. LACE-Chloride in contrast, showed more of a mixture of lipoic acid and LACE, possibly due to its lower molecular weight.

Example 15 Associative Species as a Function of the Molar Ratio of LACE-I: HP-B-CD

Previous experiments demonstrated that Hydroxypropyl Beta Cyclodextrin (HP-B-CD) could disrupt micellization of LACE-I in aqueous solution. These experiments determine the molar ratio of LACE-Iodide to Hydroxypropyl Beta Cyclodextrin (HP-B-CD required to generate thermodynamically stable inclusion complexes.

HP-β-CD + Lace-

 (HP-β-CD − Lace-Iodide] (Complete Inclusion HP-β-CD + Lace-

 (HP-β-CD − Lace-Iodide] + HP-β-CD (Complete Inclusion HP-β-CD + Lace-

 (HP-β-CD − Lace-Iodide] + Lace-Iodide (Partial Inclusion

The approach was to generate complete inclusion complexes of LACE-Iodide in HP-B-CD, thus preventing any opportunity of aggregation of LACE molecules. Several batches of formulation were prepared using varying molar ratios of LACE-Iodide to HP-B-CD and the growth of aggregative species assessed over time. The formulations were stored at 5° C. The formation of associative species as measured by reverse phase HPLC was then reported as the area percent relative to the main LACE peak area.

The results established that the formation of associative species could be prevented when there was at least a one to one molar equivalence between the concentration of LACE-I and HP-B-CD (as shown in FIG. 32 ).

Example 16 Correlation between Aggregative Species and In-Vivo Ocular Irritation

Example 16 established the correlation between concentration of associative species and ocular irritation in an in-vivo model (rabbit Draize model). The data showed that average irritation scores of 0-0.5 could be obtained when the molar equivalent ratio of LACE-Iodide:HP-B-CD was 1:1 or 1:1.5.

TABLE 12 Correlation between Associative Species and Ocular Irritation Associative Ave. % LACE-I Molar Ratio Associative Species Species Irritation Batch (w/w) Cyclodextrin CD to API (Area % vs. LACE) (% in. solution.)* Scores FK-LACE-02-09 1.92 None N/A  39% 0.75% 4.25 AC-LACE-03-18 1.92 HP-y-CD 1.0 6.4% 0.12% 0 (6.0%) AC-LACE-03-10C 4 HP-B-CD 0.54 8.4% 0.34% 4 (7.8%) AC-LACE-03-10D 4 HP-B-CD 0.35 24.9%  1.0% 6 (5.0%) AC-LACE-03-33 1.92 HP-B-CD 1.0 0.5% 0.01% 0 (7.4%) AC-LACE-03-36 3 HP-B-CD 1.0 1.3% 0.04% 0.5 (10.7%) AC-LACE-03-39 4.5 HP-B-CD 1.0 0.3% 0.014% 0 (16.1%) AC-LACE-03-54 3 HP-B-CD 1.5 0.6% 0.02% 0 (16.1%) FK-LACE-02-36 1.92 Dexolve ~0.8 BLOQ 0.0% 0 (5.8%) *Calculated by multiplying LACE-I concentration by Area % of Associative Species

Example 18 Summary of Stability Studies Of LACE-Iodide/HPBCD

Study # Purpose/Design Lot# Start Date N/A Effect of cyclodextrins vs. none; FK-LACE-02-32 13 Apr. 2016 Conditions: 5 C., 25 C. FK-LACE-02-36 13 Apr. 2016 Conditions: Glass vials, no pouch, FK-LACE-02-37 13 Apr. 2016 nitrogen overlaid 052516 Effect of cyclodextrins vs. none; AC-LACE-03-54 25 May 2016 Conditions: 25 C., simulated end-use LDPE, pouched, nitrogen overlaid, AC-LACE-03-56 25 May 2016 oxygen scavengers 0205 Effect of LACE-1 concentration and AC-LACE-05-21 1 Jul. 2016 different HPbCD/LACE-I ratios; AC-LACE-05-21B 1 Jul. 2016 Conditions: 5 C., 25 C., 40 C. AC-LACE-05-23 1 Jul. 2016 LDPE, pouched, nitrogen overlaid, AC-LACE-05-23B 1 Jul. 2016 oxygen scavengers 0214 Stability on batch prepared without AC-LACE-05-39 12 Jul. 2016 N2 purge during preparation; Conditions: 5 C., 25 C., 40 C. LDPE, pouched, nitrogen overlaid, oxygen scavengers 0225 Stability on batch prepared with 0.23% AC-LACE-07-01 19 Aug. 2016 HPMC; Conditions: 5 C., 25 C., 40 C. LDPE, no nitrogen purge, LDPE, pouched, N₂ overlaid, O₂ scavengers 0226 Stability on batch stored out of the pouch AC-LACE-05-39 19 Aug. 2016 (5 C., 25 C.) - RS only 0220 Stability on LACE API (R&D Lot) DG10_p100_060816 2 Sep. 2016 Conditions: −20 C., 5 C., 25 C. Study # Description of Formuiation Time Points Table Discussion/Comments N/A No HPbCD, control formulation 1 mo., 3 mo. #13 Dexolve, ~0.8 ME 1 mo., 3 mo. 0.73 MEHPBCD 1 mo., 3 mo. 052516 15:1 ME HPBCD, 3.0% LACE-I 1, 2, 8, 17, #14 Demonstrated 20 days protective 3.0% LACE-I, no HPbCD effect of HPbCD 0205 1:1 ME HPBCD, 3.0% LACE-I 2 wk., #15 Stable at 5 C. 1:1 ME HPBCD, 1.92% LACE-I 1, 2, 3 months Stable at 5 C. 1.5:1 ME HPBCD, 3.0% LACE-I (3 months Stable at 5 C. 1.5:1 ME HPBCD, 1.92% LACE-I on Oct. 1) Stable at 5 C. 0214 1:1 ME HPbCD, 3.0% LACE-I 2 wk, #16 Stable at 5 C., Cavasol HPbCD (better purity) 1, 2, 3 months 25 C., and 40 C., (3 months except Lipoic on Oct. 12) Acid increases at higher temperatures 0225 1:1 ME HPbCD, 3.0% LACE-I 2 wk, #17 1 month on Cavitron HPbCD (better purity) 1, 3 months Sep. 19 0.23% HPMC (Type 2910) (3 months on Nov. 19) 0226 1:1 ME HPbCD, 3.0% LACE-I 2 weeks, T0 data = 1 Cavasol HPbCD (better purity) 1 month month @ 5 C., (1 month inside the on Sep. 12) pouch (from Study# 0214) 0220 N/A 3, 6, 12, in amber 18, 24 mos. vials, (3 months pouched on Dec. 2) ME = Molar Equivalents

TABLE 13-1 FK-LACE-02-32: 1.92% LACE-Iodide Lot# 011510, Standard Formulation (no cyclodextrin) Target T0 T = 1 month @ 5° C. T = 1 month @ 25° C. Test Specification (RS: Apr. 8, 2016) (17 May 2016) (17 May 2016) Appearance Clear, slightly Complies Complies Complies yellow solution API Assay 19.2 mg/g ± 10% 15.44 mg/g 12.53 mg/g * 16.32 mg/g (17.18-21.12) API Related Repost all Oxid. LACE (2 pks.): Oxid LACE (2 pks.): Oxid. LACE (2 pks.): Substances impurities >0.05% RRT 0.48 0.13% RRT 0.48 0.88% RRT 0.45 2.78% RRT 0.52 0.09% RRT 0.52 0.47% RRT 0.52 1.3290 RRT 1.84 0.23% RRT 3.84 — Lipoic Add (RP): 0.7% ** RRT 2.00 0.18% RRT 2.00 0.32% Rest are hidden by early- RRT 2.29 0.19% Lipoic Acid(RP) 0.05% ** eluting Iodide peak due to Lipoic Acid(RP) <0.05% ** Total Imp. 1.72% Dexolve in previous sample. Total Imp. 0.79% Total Imp. 4.80% Associative Report  4.5% 36.2% 1.789% Species (RP-HPLC method) pH 4 5 ± 0.5 4.66  5.26 * 4.70 Osmolality 300 279    265     287 (mOsm/kg) (280-320) * May need to be repeated from 2^(nd) vial stored at 5° C., which has not been sampled as much. ** Lipoic Acid estimated from Area % of RRT 1.17 peal in RP-HPLC method used for Associative Species determination.

-   Due to repeated sampling and/or the storage conditions (lacking a     foil bag with oxygen absorbers), this formulation shows some     oxidative degradation. -   As the Associative Species increased (1 month @5° C.), the     Osmolality decreased

TABLE 13-2 FK-IACE-02-37: 1.92% LACE-Iodide lot# 011510, Formulation with 5% HP-JJ-CD (~0.75:1 mole ratio of HPBCD:LACE) Target T0 T = 1 month @ 5° C. T - 1 month @ 25° C. API (Lot# 011510) Test Specification (RS: Apr. 11, 2016) (17 May 2016) (17 May 2016) RS analyzed Mar. 22, 2016 Appearance Clear, slightly Complies Complies Complies Complies yellow solution API Assay 19.2 mg/g ± 10% 18.97 mg/g ** 17.54 mg/g 17.57 mg/g N/A (17.18-21.12) API Related Report all Oxid. LACE (3 pks.): Oxid. LACE (3 pks.): Oxid. LACE (2 pks.): Oxid. LACE (2 pks.): Substances impurities >0.05% RRT 0.40 0.05% RRT 0.45 0.05% RRT 0.48 1.77% RRT 0.48 0.08% RRT 0.48 0.04% RRT 0.48 0.20% RRT 0.52 0.53% RRT 0.52 0.04% RRT 0.52 0.02% RRT 0.52 0.10% RRT 2.00 0.50% RRT 1.74 0.24% RRT 2.00 0.46% RRT 2.00 0.54% Lipoic Acid (RP) 1.1% RRT 2.00 0.20% Lipoic Acid(RP) <0.05% Lipoic Acid(RP) 0.1% Total Imp. 3.90% Total Imp. 0.56% Total Imp. 0 57% Total Imp. 0.99% Associative Report 0.0% 0.0% (9 May 2016 - 27 days) 0.18% N/A Species (RP-HPLC method) pH 4.5 ± 0.5 4.78     5.39 *** 4.81 N/A Osmolality 300 297 306 310 N/A (mOsm/kg) (280-320) ** Previously reported 21.3 mg/g. Due to pump problems on HPLC causing a shift in retention times, the standard curve used in the earlier determination is now in question. Result reported here is based on current standard curve applied to 22 Apr. 2016 run. *** May need to be repeated from 2^(nd) vial stored at 5° C., which has not been sampled as much.

Comments

-   Despite repeated handling, the related substances in this lot have     not substantially increased. -   This compares favorably with the FK-LACE-02-32 batch (without     cyclodextrin) which was placed on stability at the same time under     the same storage conditions, and shows larger increases in oxidized     LACE impurities at both 5° C. and 25° C. -   This comparison indicates that the cyclodextrin may partially     protect the LACE molecule from oxidation.

TABLE 14 Stabilization of LACE-Iodide by Hydroxypropyl Beta Cyclodextrin 3.0% LACE-I, Conditions: Stored at 25° C., LDPE Dropper bottles, AC-LACE- 16.1% HPBCD blanketed with N₂ initially, no pouching or oxygen scavenger 03-54 Specifications T = 24 h T = 48 h Related Single unknown: RRT 0.39 0.19% RRT 0.39 0.19% Substances NMT 0.5% RRT 0.51 0.10% RRT 0.51 0.09% Total unknowns: REIT 0.54 0.14% RRT 0.54 0.14% NMT 2.0% RRT 0.62 0.04% RRT 0.62 0.04% Lipoic Acid: RRT 0.67 0.03% RRT 0.67 0.04% NMT 1.0% Lipoate 0.25% Lipoate 0.29% RRT 1.55 0.11% RRT 1.55 0.10% Lipoic Acid 0.30% Lipoic Acid 0.15% Total Unk. 0.61% Total Unk. 0.60% Total Imp. 1.16% Total Imp. 1.04% Conditions: Stored at 25° C., LDPE Dropper bottles, AC-LACE- blanketed with N₂ initially, no pouching or oxygen scavenger 03-54 T = 8 days T = 17 days T = 20 days Related RRT 0.39 0.19% RRT 0.39 0.12% RRT 0.39 0.18% Substances RRT 0.51 0.39% RRT 0.51 1.04% RRT 0.51 1.49% RRT 0.54 0.05% RRT 0.54 0.14% RRT 0.54 0.31% RRT 0.62 0.04% RRT 0.62 0.13% RRT 0.62 0.20% RRT 0.67 — RRT 0.67 — RRT 0.67 — Lipoate 0.26% Lipoate 0.24% Lipoate 0.36% RRT 1.55 0.11% RRT 1.55 0.11% RRT 1.55 0.11% Lipoic Acid 0.11% Lipoic Acid 0.11% Lipoic Acid 0.21% Total Unk. 0.78% Total Unk. 1.54% Total Unk. 2.29% Total Imp. 1.15% Total Imp. 1.89% Total Imp. 2.86% 3.0% LACE-I Conditions: Stored at 25° C., LDPE Dropper bottles, AC-LACE- NoHPBCD blanketed with N₂ initially, no pouching or oxygen scavenger 03-56 Specifications T = 24 h T = 48 h Related Single unknown: RRT 0.39 0.36% RRT 0.40 0.37% Substances NMT 0.5% RRT 0.63 0.48% RRT 0.57 0.11% Total unknowns: RRT 0.71 0.14% RRT 0.63 0.25% NMT 2.0% RRT 0.76 0.17% RRT 0.71 0.15% Lipoic Acid: Lipoate 0.18% RRT 0.76 0.16% NMT 1.0% RRT 1.55 0.14% Lipoate 0.21% Lipoic Acid 0.21% RRT 1.59 0.13% Total Unk. 1.29% RRT 1.69 0.11% Total Imp. 1.68% Lipoic Acid 0.17% Total Unk. 1.28% Total Imp. 1.66% Conditions: Stored at 25° C., LDPE Dropper bottles, AC-LACE- blanketed with N₂ initially, no pouching or oxygen scavenger 03-56 T = 8 days T = 17 days T = 20 days Related RRT 0.41 0.35% RRT 0.40 0.37% RRT 0.41 0.26% Substances RRT 0.51 0.38% RRT 0.50 1.60% RRT 0.51 2.84% RRT 0.57 0.82% RRT 0.52 0.52% RRT 0.59 0.82% RRT 0.64 0.36% RRT 0.55 1.10% RRT 0.62 0.85% RRT 0.68 0.37% RRT 0.61 0.81% RRT 0.67 — Lipoate 0.17% RRT 0.67 0.92% Lipoate 0.24% RRT 1.57 0.07% Lipoate 0.27% RRT 1.45 0.21% Lipoic Acid 0.28% RRT 1.45 0.17% RRT 1.52 0.51% Total Unk. 2.35% RRT 1.52 0.49% RRT 1.67 0.05% Total Imp. 2.80% RRT 1.65 0.06% Lipoic Acid 0.06% Lipoic Acid 0.07% Total Unk. 5.54% Total Unk. 6.04% Total Imp. 5.84% Total Imp. 6.38%

TABLE 15-1 (Study #0205) Effect of LACE-I concentration and different LACE-Iodide/HPBCD Molar Ratios Lot# AC-LACE-05-21 Description 3% LACE-I/HPBCD Molar Equivalents of API:HPbCD 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N₂ overlay Conditions 5 C. Lot # AC-LACE-05-21, 5° C.; Start Bate: Jul. 1, 2016 Test Specification T = 0 2 Week 4 Weeks 2 Month 3 Month API Appearance Clear, Light Yellow PASS PASS PASS PASS pH 4.5 (4.0-5.0) 4.6 — — — Osmolality 300 (280-320) mOsm 303 307 310 — Associatvie TBD BLOQ BLOQ BLOQ BLOQ Species Viscosity TBD — — — — Assay, API 30 (27-33) mg/g 33.0 31.0 32.6 — Related Report All RRT Impurity Area % Area % Area % Area % Area % Area % Substances Impurities > 0.05% 0.51 Oxidized 0.06 0.12 0.21 — 0.19 0.68 Lace 0.03 0.02 0.05 0.04 1.00 API 98.95  99.40 99.07 99.13  1.65 0.26 0.29 0.38 0.34 1.86 0.08 0.08 0.13 0.17 4.05 Lipoic 0.50 ND 0.06 0.13 Acid Total Impurities 1.05 0.60 0.93 0.87

TABLE 15-2 (Study #0205) Effect of LACE-I concentration and different LACE-Iodide/HP-B-CD Molar Ratios Lot# AC-LACE-05-21 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 25 C. Lot # AC-LACE-05-21, 25° C.; Start Date: Jul. 1, 2016 Test Specification T = 0 2 Week 4 W eeks 2 Month 3 Month API Appearance Clear, Light Yellow PASS PASS PASS PASS pH 4.5 (4.0-5.0) 4.6 — — — Osmolality 300 (280-320) mOsm 303 308 304 — Associative TBD BLOQ BLOQ BLOQ BLOQ Specie Viscosity TBD — — — — Assay, API 30 (27-33) mg/g 33.0 30.8 32.5 — Related Report All RRT Impurity Area % Area % Area % Area % Area % Area % Substance Impurities > 0.05% 0.51 0.06 0.17 0.29 — 0.19 0.68 Oxidized 0.03 0.85 1.87 0.04 Lace 1.00 API 98.95  98.07 96.62 99.13  1.65 0.26 0.37 0.32 0.34 1.86 0.08 0.26 0.31 0.17 4.05 Lipoic 0.50 0.18 0.39 0.13 Acid Total Impurities 1.05 1.93 3.38 0.87

TABLE 15-3 (Study #0205) Effect of LACE-1 concentration and different LACE-lodide/HPBCD Molar Ratios Lot# AC-LACE-05-21 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 40 C. Lot # AC-LACE-05-21, 40° C.; Start Date: Jul. 1, 2016 Test Specification T = 0 2 Weeks 4 Weeks 2 Months 3 Months API Appearance Clear, Light PASS PASS PASS PASS Yellow pH 4.5 (4.0-5.0) 4.6 — — — Osmolality 300 (280- 303 312 310 — 320) mOsm Associative TBD BLOQ BLOQ BLOQ BLOQ Specie Viscosity TBD — — — — Assay, API 30 (27-33) 33.0 30.8 32.1 — mg/g Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area% Area % 0.51 0.06 0.18 0.38 0.19 0.68 Oxidized 0.03 6.46 8.18 0.04 Lace 1.00 API 98.85 91.97 89.23 99.13 1.65 0.26 0.22 0.26 0.34 1.86 0.08 0.32 0.50 0.17 4.05 Lipoic 0.50 0.65 1.32 0.13 Acid Total Impurities 1.05 8.03 10.77 0.87

TABLE 15-4 (Study #0205) Effect of LACE-I concentration and different LACE-Iodide/HPBCD Molar Ratios Lot# AC-LACE-05-21B Description 1.92% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 5 C. Lot # AC-LACE-05-21B, 5° C.; Start Date: Jul. 1, 2016 Test Specification T = 0 2 Weeks 4 Weeks 2 Months 3 Months API Appearance Clear, Light PASS PASS PASS PASS Yellow pH 4.5 (4.0-5.0) 4.5 — — — Osmolality 300 (280- 299 307 305 — 320) mOsm Associative TBD BLOQ BLOQ BLOQ BLOQ Specie Viscosity TBD — — — — Assay, API 30 (27-33) 20.5 19.4 20.8 mg/g Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % Area % 0.51 0.07 0.11 0.20 — 0.19 0.53 ND ND 0.09 0.68 Oxidized 0.0.3 ND 0.05 0.04 Lace 1 API 99.35 99.37 99.01 99.13 1.65 0.35 0.22 0.41 0.34 1.86 0.09 0.13 0.19 0.17 2.28 ND 0.08 ND 4.05 Lipoic ND 0.03 ND 0.13 Acid Total Impurities 0.65 0.63 0.99 0.87

TABLE 15-5 (Study #0205) Effect of LACE-I concentration and different LACE-Iodide/HPBCD Molar Ratios Lot# AC-LACE-05-21B Description 1.92% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 25 C. Lot# AC-LACE-05-21B, 25° C.; Start Date: Jul. 1, 2016 Test Specification T = 0 2 Weeks 4 Weeks 2 Months 3 Months API Appearance Clear, Light PASS PASS PASS PASS Yellow pH 4.5 (4.0-5.0) 4.5 — — — Osmolality 300 (280- 299 308 305 — 320) mOsm Associative TBD BLOQ BLOQ BLOQ BLOQ Specie Viscosity TBD — — — — Assay, API 30 (27-33) 20.5 19.5 20.7 — mg/g Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % Area % 0.51 0.07 0.12 0.24 — 0.19 0.53 ND ND 0.11 0.68 Oxidized 0.0.3 1.01 4.40 0.04 Lace 1 API 99.35 97.91 94.04 99.13 1.65 0.35 0.36 0.30 0.34 1.86 0.09 0.31 0.47 0.17 2.28 ND 0.09 ND 4.05 Lipoic ND 0.14 0.40 0.13 Acid Total Impurities 0.65 2.08 5.96 0.87

TABLE 15-6 (Study #0205) Effect of LACE-1 concentration and different LACE-lodide/HPBCD Molar Ratios Lot# AC-LACE-05-21B Description 1.92% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 4° C. Lot# AC-LACE-05-21B, 40° C.; Start Date: Jul. 1, 2016 Test Specification T = 0 2 Weeks 4 Weeks 2 Months 3 Months API Appearance Clear, Light PASS PASS PASS PASS Yellow pH 4.5 (4.0-5.0) 4.5 — — — Osmolality 300 (280- 299 312 308 — 320) mOsm Associative TBD BLOQ BLOQ BLOQ BLOQ Specie Viscosity TBD — — — — Assay, API 30 (27-33) 20.5 19.6 20.4 — mg/g Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % Area % 0.51 0.07 0.17 0.32 — 0.19 0.53 ND ND 0.05 0.68 Oxidized 0.03 14.01 16.95 0.04 Lace 1 API 99.35 84.49 89.46 99.13 1.65 0.35 0.28 0.28 0.34 1.86 0.09 0.27 0.51 0.17 2.28 ND 0.10 ND 4.05 Lipoic ND 0.67 1.27 0.13 Acid Total Impurities 0.65 15.51 10.54 0.87

TABLE 15-7 (Study #0205) Effect of LACE-I concentration and different LACE-lodide/HPBCD Molar Ratios Lot# AC-LACE-05-23 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1.5 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 5 C. Lot # AC-LACE-05-23, 5° C.; Start Date: Jul. 1, 2016 Test Specification T = 0 2 Weeks 4 Weeks 2 Months 3 Months API Appearance Clear, Light PASS PASS PASS PASS Yellow pH 4.5 (4.0-5.0) 4.5 — — — Osmolality 300 (280- 297 300 298 — 320) mOsm Associative TBD BLOQ BLOQ BLOQ BLOQ Specie Viscosity TBD — — — — Assay, API 30 (27-33) 32.0 32.2 32.2 — mg/g Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % Area % 0.49 0.05 0.09 0.18 — 0.19 0.52 ND ND 0.06 0.61 Oxidized 0.04 0.04 0.08 0.04 Lace 1.00 API 99.10 99.29 98.45 99.13 1.52 0.34 0.39 0.42 0.34 1.73 0.07 0.08 0.17 0.17 4.11 0.28 ND 0.06 0.13 Total Impurities 0.68 0.71 1.55 0.87

TABLE 15-8 (Study #0205) Effect of LACE-I concentration and different LACE-Iodide/HPBCD Molar Ratios Lot# AC-LACE-05-23 Description 1.92% LACE-I/HPBCD Molar Equivalents of 1:1.5 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 25 C. Lot # AC-LACE-05-23, 25° C.; Start Date: Jul. 1, 2016 Test Specification T = 0 2 Weeks 4 Weeks 2 Months 3 Months API Appearance Clear, Light PASS PASS PASS PASS Yellow pH 4.5 (4.0-5.0) 4.6 — — — Osmolality 300 (280- 297 300 297 — 320) mOsm Associative TBD BLOQ BLOQ BLOQ BLOQ Specie Viscosity TBD — — — — Assay, API 30 (27-33) 32.0 32.2 32.2 — mg/g Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % Area % 0.49 0.05 0.09 0.21 — 0.19 0.52 ND ND 0.07 0.61 Oxidized 0.04 0.04 3.56 0.04 Lace 1.00 API 99.10 99.29 95.00 99.13 1.52 0.34 0.39 0.32 0.34 1.73 0.07 0.08 0.30 0.17 4.11 Lipoic 0.28 ND 0.38 0.13 Acid Total Impurities 0.68 0.71 5.00 0.87

TABLE 15-9 (Study #0205) Effect of LACE-I concentration and different LACE-lodide/HPBCD Molar Ratios Lot# AC-LACE-05-23 Description 3% LACE-1/HPBCD Molar Equivalents of 1:1.5 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 40 C. Lot # AC-LACE-05-23, 40° C.; Start Date: Jul. 1, 2016 Test Specification T = 0 2 Weeks 4 Weeks 2 Months 3 Months API Appearance Clear, Light PASS PASS PASS PASS Yellow pH 4.5 (4.0-5.0) 4.5 — — — Osmolality 300 (280- 297 301 299 — 320) mOsm Associative TBD BLOQ BLOQ BLOQ BLOQ Specie Viscosity TBD — — — — Assay, API 30 (27-33) 32.0 32.2 32.2 — mg/g Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % Area % 0.49 0.05 0.13 0.15 — 0.19 0.61 Oxidized 0.04 27.07 21.07 0.04 Lace 1.00 API 99.10 71.56 76.39 99.13 1.52 0.34 0.23 0.29 0.34 1.73 0.07 0.41 0.52 0.17 4.11 Lipoic 0.28 0.48 1.18 0.13 Acid Total Impurities 0.68 2.13 23.61 0.87

TABLE 16-1 (Study #0214) “No Nitrogen” Processing of LACE-Iodide in HPBCD: Effect on Stability Lot# AC-LACE-05-3 9 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched. Oxygen Scavenger, N2 overlay Conditions 5 C. Lot # AC-LACE-05-39, 5° C.; Start Date: Jul. 13, 2016 Test Specification T = 0 2 Week 1 Month 2 Month 3 Month API Appearance Clear, Light Yellow PASS PASS PASS pH 4.5 (4.0-5.0) 4.7 — Osmolality 300 (280-320) mOsm 304 302 298 Associative Species TBD BLOQ BLOQ BLOQ Viscosity TBD — — — Assay, API 30 (27-33) mg/g 31.6 32.7 31.3 Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % 0.51 API 0.08 0.16 0.09 0.10 0.53 0.03 ND 0.03 ND 0.68 ND ND 0.04 0.04 0.93 ND ND 0.05 ND 1.00 99.26 99.19 99.19 99.13 1.36 0.10 ND 0.05 ND 1.65 0.39 0.42 0.42 0.34 1.86 0.04 0.09 0.07 ND 2.28 ND 0.08 0.07 0.17 4.05 Lipoic ND ND 0.06 0.13 Acid Total Impurities 0.74 0.81 0.81 0.87

TABLE 16-2 (Study #0214) “No Nitrogen” Processing of LACE-Iodide in HPBCD: Effect on Stability Lot# AC-LACE-05-39 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# LDPE, Pouched, Oxygen Scavenger, N2 overlay Container Closure Conditions 25 C. Lot # AC-LACE-05-39, 25° C.; Start Date: Jul. 13, 2016 Test Specification T = 0 2 Week 1 Month 2 Month 3 Month API Appearance Clear, Light Yellow PASS PASS PASS pH 4.5 (4.0-5.0) 4.7 — Osmolality 300 (280-320) mOsm 304 300 299 Associative Species TBD BLOQ BLOQ BLOQ Viscosity TBD — — Assay, API 30 (27-33) mg/g 31.6 33.3 30.3 Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % 0.51 API 0.08 0.20 0.17 0.10 0.53 Lipoic 0.03 0.04 0.04 ND 0.68 Acid ND ND 0.06 0.04 0.93 ND ND 0.04 ND 1.00 99.26 99.82 98.46 99.13 1.23 ND ND 0.25 ND 1.36 0.10 0.08 0.06 0.34 1.65 0.39 0.41 0.40 ND 1.86 0.04 0.11 ND 0.17 2.28 ND 0.09 0.09 0.13 4.05 ND 0.21 0.43 Total Impurities 0.74 1.18 1.54 0.87

TABLE 16-3 (Study #0214) “No Nitrogen” Processing of LACE-Iodide in HPBCD: Effect on Stability Lot# AC-LACE-05-39 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 4° C. Lot # AC-LACE-05-39, 40° C.; Start Date: Jul. 13, 2016 Test Specification T = 0 2 Week 1 Month 2 Month 3 Month API Appearance Clear, Light Yellow PASS PASS PASS pH 4.5 (4.0-5.0) 4.7 — Osmolality 300 (280-320) mOsm 304 302 302 Associative Species TBD BLOQ BLOQ BLOQ Viscosity TBD — — — Assay, API 30 (27-33) mg/g 31.6 33.7 31.1 Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % Area % 0.51 API 0.08 0.36 0.20 0.10 0 53 Lipoic 0.03 ND ND ND 0.68 Acid ND ND 0.12 0.04 0.93 ND ND ND ND 1.00 99.26 97.93 97.19 99.13 1.36 0.10 0.11 0.33 ND 1.65 0.39 0.32 ND 0.34 1.86 0.04 0.18 0.29 ND 2.28 ND 0.06 0.08 0.17 4.05 ND 1.01 1.80 0.13 Total Impurities 0.74 2.08 2.81 0.87

TABLE 17-1 (Study #0225) LACE-Iodide Formulation in Cavitron HPBCD and 0.23% HPMC Effect on Stability Lot# AC-LACE-07-01 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 5 C. Lot # AC-LACE 05-39, 40° C.; Start Date: Jul. 13, 2016 Test Specification T = 0 2 Week 1 Month 3 Month API Appearance Clear, Light Yellow PASS PASS PASS pH 4.5 (4.0-5.0) 4.6 — Osmolality 300 (280-320) mOsm 280 — Associative Species TBD — Viscosity TBD 10 — Assay, API 30 (27-33) mg/g 28.6 29.4 Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % 0.50 API 0.04 0.12 0.20 0.59 Lipoic 0.07 0.09 0.04 0.74 Acid 0.02 0.04 0.86 0.08 0.04 0.91 0.02 ND 3.00 99.15 99.18 99.13 1.13 0.08 0.15 1.27 0.38 0.32 0.34 1.42 0.07 0.08 0.17 3.07 ND ND 0.13 Total Impurities 0.85 0.82 0.87

TABLE 17-2 (Study #0225) LACE-lodide Formulation in Cavitron HPBCD and 0.23% HPMC Effect on Stability Lot# AC-LACE-07-01 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 25 C. Lot # AC-LACE-07-01, 25° C.; Start Date: Aug. 19, 2016 Test Specification T = 0 2 Week 1 Month 3 Month API Appearance Clear, Light Yellow PASS pH 4.5 (4.0-5.0) 4.6 Osmolality 300 (280-320) mOsm 280 Associative Species JBD Viscosity TBD 10 Assay, API 30 (27-33) mg/g 28.6 Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % 0.50 API 0.04 0.15 0.20 0.59 0.07 0.10 0.04 0.74 0.02 0.02 0.86 0.08 0.025 0.91 0.02 ND 1.00 99.15 98.93 99.13 1.33 0.08 ND 1.27 0.38 0.49 0.34 1.42 Lipoic 0.07 0.07 0.17 Acid ND 0.21 0.13 Total Impurities 0.85 1.07 0.87

TABLE 17-3 (Study #0225) LACE-lodide Formulation in Cavitron HPBCD and 0.23% HPMC Effect on Stability Lot# AC-LACE-07-01 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, Pouched, Oxygen Scavenger, N2 overlay Conditions 4° C. Lot # AC-LACE-97-01, 40° C.; Start Date: Aug. 19, 2016 Test Specification T = 0 2 Week 1 Month 3 Month API Appearance Clear, Light Yellow PASS pH 4.5 (4.0-5.0) 4.6 Osmelality 300 (280-320) mOsm 280 Associative Species I&C Viscosity BD 10 Assay, APL 30 (27-33) mg/g 28.6 Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % 0.50 APE 0.04 0.19 0.20 0.59 0.07 0.14 0.04 0.74 0.02 ND 0.86 0.08 ND 0.91 0.02 ND 1.00 99.15 98.19 99.13 1.13 0.08 0.20 1.27 0.38 0.37 0.34 1.42 0.07 0.08 0.17 3.07 Lipoic 0.84 0.13 Acid Total Impurities 0.85 1.82 0.87

TABLE 18-1 (Study #0226) LACE-Iodide Formulation in Cavitron HPBCD in Molar Ratto 1:1 (Stored with no oxygen protection (no O2 scavengers, no N2 overlay, no pouch) Effect on Stability Lot# AC-LACE-05-39 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 APT Lot# Container Closure LDPE, no O2 scavengers, no N2 overlay, no pouch Conditions 5 C. Lot # AC-LACE-05-39, 5° C.; Removed O2 Scavengers: Aug. 19, 2016 T0 CONTROL Initial (With O2 2 Weeks 4 Weeks (with Bottling Scavengers 1 (No O2 (No O2 O2 Test Specification Jul. 13, 2016 Months) Scavengers) Scavengers) Scavengers 2 API Appearance Clear, Light Yellow PASS PASS PASS pH 4.5 (4.0-5.0) 4.7 — Osmolality 300 (280-320) mOsm 304 298 — Associative Species TBD BLOQ BLOQ — Viscosity TBD — — — Assay, API 30 (27-33) mg/g 31.6 31.3 — Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % 0.51 0.08 0.09 0.13 0.10 0.53 0.03 0.03 0.04 ND 0.68 ND 0.04 0.06 0.04 0.93 ND 0.05 ND ND 1.00 API 99.6 99.19 98.78 99.13 1.2 ND ND 0.105 ND 1.36 0.10 0.05 0.39 ND 1.65 0.39 0.42 0.35 0.34 1.86 0.04 0.07 ND ND 2.28 ND 0.07 ND 0.17 4.05 Lipoic ND 0 06 0.15 0.13 Acid Total Impurities 0.74 0.81 1.22 0.87

TABLE 18-2 (Study #0226) LACE-Iodide Formulation in Cavitron HPBCD in Molar Ratio 1:1 (Stored with no oxygen protection (no O2 scavengers, no N2 overlay, no pouch) Effect on Stability (5<, 25<) Lot# AC-LACE-05-39 Description 3% LACE-I/HPBCD Molar Equivalents of 1:1 API Lot# Container Closure LDPE, no O2 scavengers, no N2 overlay, no pouch Conditions 25 C. Lot # AC-LACE-05-39, 25° C.; Removed O2 Scavengers: Aug. 19, 2016 T0 CONTROL Initial (With O2 2 Weeks 4 Weeks (with O2 Bottling Scavengers 1 (No O2 (No O2 Scavengers Test Specification Jul. 13, 2016 Months) Scavengers) Scavengers) 2 Months API Appearance Clear, Light Yellow PASS PASS PASS pH 4.5 (4.0-5.0) 4.7 — Osmolality 300 (280-320) mOsm 304 298 — Associative Species TBD BLOQ BLOQ — Viscosity TBD — — — Assay, API 30 (27-33) mg/s 31.6 31.3 — Report All Related Impurities > Substances 0.05% RRT Impurity Area % Area % Area % Area % 0.51 0.08 0.09 0.37 0.10 0.53 0.03 0.03 0.16 ND 0.68 ND 0.04 0.19 0.04 0.93 ND 0.05 ND ND 1.00 API 99.26 99.19 98.47 99.13 1.2 ND ND 0.15 ND 1.36 0.10 0.05 0.38 ND 1.65 0.39 0.42 ND 0.34 1.86 0.04 0.07 ND ND 2.28 ND 0.07 ND 0.17 4.05 Lipoic ND 0.06 0.29 0.13 Acid Total impurities 0.74 0.81 1.53 0.87

Example 19 Method of Formulation for LACE-Iodide Drug Product Solution General Process Sequence LAC-I/HPbCD (No HPMC)

-   1. Into a beaker add in order: WFI, alanine, glycerol, HP-B-CD, and     Benzalkonium Chloride solution (BAK 0.005 g/mL in WFI). -   2. Place beaker on magnetic stirrer to combine excipients. -   3. Adjust pH using 1 N HCl, target pH 4.5 -   4. Place beaker into jacketed vessel hooked up to water     heater/chiller circulator set to 25° C. (add distilled water to     jacketed vessel for thermal conductivity). Immerse Scilogix mixing     paddle and stir at approximately 500 RPM. -   5. Add API in small increments while stirring. Upon completion of     the addition of the API, allow formulation to stir for 45-60 minutes     to ensure complete dissolution, -   6. Remove beaker from mixing apparatus and weigh. Add WFI for     account for any loss due to evaporation. -   7. Filter formulation (0.2 uM PVDF).     LACE-I With 0.23% HPMC (two solution process)

A. Solution 1-1.16% (w/w) Hypromeilose 2910 solution in WFI

-   -   1. Into a beaker add WH.     -   2. Place beaker into jacketed vessel hooked up to water         heater/chiller circulator set to 90 ° C. (add distilled water to         jacketed vessel for thermal conductivity). Immerse Sciolgex         mixing paddle and stir at approximately 400 RPM.     -   3. Once WFI is 2:70° C., begin adding Hypromellose 2910 to         disperse. Increase mixing speed to 650 RPM.     -   4. Once all HPMC has been added, reduce temperature of         heater/chiller water circulator to 10° C. and continue to mix.     -   5. When solution has cooled and become clear and viscous, remove         beaker from mixing apparatus and weigh. Add WFI for account for         any loss due to evaporation.

B. Solution 2—LACE-Formulation without HPMC

-   -   1. into a beaker add in order: WFI, alanine, glycerol, HP-13-CD

2. Place beaker into jacketed vessel hooked up to water heater/chiller circulator set to 25 ° C. (add distilled water to jacketed vessel for thermal conductivity). Immerse Sciolgex mixing paddle and stir at approximately 500 RPM.

-   -   3. Adjust pH using 1 N HCl to 4.18     -   4. Add API in small increments while stirring. Upon completion         of the addition of the API, allow formulation to stir for 45-60         minutes to ensure complete dissolution.     -   5. Add BAK solution (BAK 0.005 g/mL in WFI).     -   6, Remove beaker from mixing apparatus and weigh. Add WFI for         account for any loss due to evaporation.     -   7. Measure pH and adjust if necessary.

C. Combine Solutions I and 2

-   -   1. Weigh out a designated portion of Solution 1 into a beaker.     -   2. Place beaker into jacketed vessel hooked up to water         heater/chiller circulator set to 25 ° C. (add distilled water to         jacketed vessel for thermal conductivity). Immerse Sciolgex         mixing paddle and stir at approximately 130 RPM.     -   3. Add solution 2 into solution 1 while mixing.     -   4. Remove beaker from mixing apparatus.     -   5. Sterile filter using 0.2 μM PVDF filter. 

1. A stable and biocompatible composition of matter for the treatment of presbyopia comprising a pharmaceutical salt of 0.1-10% lipoic acid choline ester, 1-30% of a cyclodextrin, 0.1-2% of a tonicity adjusting agent, 0.1-0.5% of a viscosity enhancement agent, 0.05% to about 1.0% of a biochemical energy source and water for injection.
 2. The composition of claim 1, wherein the cyclodextrin comprises hvdroxypropyl beta cyclodextrin in the concentration range 0.1.-0.5%.
 3. The composition of claim 2, wherein the tonicity adjusting agent comprises glycerol or sodium chloride.
 4. (canceled)
 5. The composition of claim 1, further comprising a stabilizer selected from the group consisting of methionine, cysteine and histidine.
 6. The composition of claim 5, further comprising benzalkonium chloride as the preservative.
 7. The composition of claim 6, comprising alanine as the biochemical energy source.
 8. The composition of claim 1, wherein the pharmaceutical salt of the lipoic acid choline ester is a chloride or an iodide.
 9. The composition of any one of claim 1, wherein the composition is preservative free.
 10. A method of producing the stable and biocompatible pharmaceutical composition according to claim 1, comprising: A. finely grinding the lipoic acid choline ester, B. adding the lipoic acid acid choline ester, cyclodextrin, tonicity adjusting agent, viscosity enhancement agent, biochemical energy source, and optionally a preservative to water that is de-oxygenated to less than 5 ppm with an inert gas to form a component mixture C. vigorously mixing the component mixture at room temperature D. filling ophthalmic bottles with the component mixture E. packaging the filled-and-capped ophthalmic bottles in gas-impermeable foil pouches, said pouches containing an oxy gen scavenger, and an inert gas, F. storing the packages at 2-8C.
 11. The method of claim 10, in which the component mixture pH is adjusted to a pH range of 4-5.
 12. The method of claim 10, in which the mixing is performed under a nitrogen blanket or under ambient air.
 13. (canceled)
 14. The method of claim 10, in which the final package contains a nitrogen overlay.
 15. The method of claim 10, in which the lipoic acid choline ester is ground into finely divided powder of an average size of 5 mm or less.
 16. The method of claim 10, in which the deoxygenation level is 2 ppm.
 17. The method of claim 10, in which temperature of mixing is between 20-25C.
 18. The method of claim 10, in which the components are mixed for 8 hours.
 19. The method of claim 10, in which the inert gas is nitrogen.
 20. The method of claim 10, in which the ophthalmic bottle is Type 1 pharmaceutical glass, HDPE, PP, LDPE, PET or PTFE.
 21. The method of claim 10, wherein the ophthalmic bottle is a blow-fill-seal unit.
 22. The method of claim 10, wherein the ophthalmic bottle is a multi-dose unit.
 23. (canceled)
 24. (canceled) 